1457304586 NPI number — MAUSTON AREA AMBULANCE ASSOCIATION INC

Table of content: (NPI 1457304586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457304586 NPI number — MAUSTON AREA AMBULANCE ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAUSTON AREA AMBULANCE ASSOCIATION INC
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:
1457304586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAUSTON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53948-0052
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:
302 S UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAUSTON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53948-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-853-0988
Provider Business Practice Location Address Fax Number:
608-350-9759
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
608-547-4792

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: 41335900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000085266 . This is a "ADVOCARE MCHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41335900 . This is a "HIRSP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0595439 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012213 . This is a "PHYSICIAN'S PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 971482100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: WI0101 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8180065 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".




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