1942253349 NPI number — MAIDEN ROCK, PLUM CITY, STOCKHOLM AREA AMBULANCE

Table of content: (NPI 1942253349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942253349 NPI number — MAIDEN ROCK, PLUM CITY, STOCKHOLM AREA AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAIDEN ROCK, PLUM CITY, STOCKHOLM AREA AMBULANCE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942253349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 MAPLE AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLUM CITY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54761-9015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLUM CITY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54761-9002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-647-2141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILLES
Authorized Official First Name:
KENT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
715-647-2141

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8181636 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47033MA . This is a "ATRIUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41311200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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