Healthcare Provider Details

I. General information

NPI: 1669488466
Provider Name (Legal Business Name): OLIVIA AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/22/2022
Certification Date: 05/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W LINCOLN AVE
OLIVIA MN
56277
US

IV. Provider business mailing address

PO BOX 97
OLIVIA MN
56277-0097
US

V. Phone/Fax

Practice location:
  • Phone: 320-523-5565
  • Fax: 320-523-1232
Mailing address:
  • Phone: 320-579-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0183
License Number StateMN

VIII. Authorized Official

Name: JULIE WERTISH
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 320-579-0408