THERESA AMBULANCE SERVICE; NPI #1104804657

Contact Information

THERESA AMBULANCE SERVICE

302 DEPOT ROAD
THERESA, WI 53091

Phone: 920-488-6301
Fax: 920-488-6301
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Land Transport	3416L0300X	59	Ambulance Service Provider

Indicates primary specialty

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NPI Profile & details for THERESA AMBULANCE SERVICE

NPI # 1104804657

LBN Legal business name THERESA AMBULANCE SERVICE

Authorized official KEVIN BAERWALD - (OPERATION MANAGER)

Entity Organization

Organization subpart ¹ No

Enumeration date 01/05/2006

Last updated 04/30/2012 - About 14 years ago

Identifiers

WI	License #	6000326
WI	Medicaid	41328600

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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