1740231117 NPI number — OCONTO FALLS AREA JOINT AMBULANCE SERVICE INC

Table of content: (NPI 1740231117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740231117 NPI number — OCONTO FALLS AREA JOINT AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCONTO FALLS AREA JOINT 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:
1740231117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
831 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCONTO FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54154-1241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-846-2662
Provider Business Mailing Address Fax Number:
920-846-2676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
831 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCONTO FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54154-1241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-846-2662
Provider Business Practice Location Address Fax Number:
920-846-2676
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AHLGRIM
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
W
Authorized Official Title or Position:
SERVICE DIRECTOR
Authorized Official Telephone Number:
920-846-2662

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: 41336300 . This is a "HIRSP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0157163-00 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012283 . This is a "PHYSICIAN'S PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41336300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4631821 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2494 . This is a "NETWORK HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 396005559010 . This is a "VALLEY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: BCBS . This is a "396005559010" identifier . This identifiers is of the category "OTHER".
  • Identifier: 396005559010 . This is a "MEDICARE BLUE MCHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000085332 . This is a "ADVOCARE MCHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0157163-00 . This is a "MEDICAL ASSOCIATES HMO" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: WI0101 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".




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