1659466043 NPI number — WINONA AREA AMBULANCE SERVICE, INC.

Table of content: (NPI 1659466043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659466043 NPI number — WINONA AREA AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINONA AREA AMBULANCE SERVICE, 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:
1659466043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 WEST 2ND STREET
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WINONA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-452-5351
Provider Business Mailing Address Fax Number:
507-452-0764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 WEST 2ND STREET
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WINONA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-452-5351
Provider Business Practice Location Address Fax Number:
507-452-0764
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD OF DIRECTORS-TREASURER
Authorized Official Telephone Number:
507-457-4156

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0272 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 6001363 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7G848WI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 165217600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41353600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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