Healthcare Provider Details

I. General information

NPI: 1609827997
Provider Name (Legal Business Name): ELLSWORTH AREA AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S PLUM ST
ELLSWORTH WI
54011-4137
US

IV. Provider business mailing address

PO BOX 718
ELLSWORTH WI
54011-0718
US

V. Phone/Fax

Practice location:
  • Phone: 715-273-4879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: DAN MORTH
Title or Position: DIRECTOR
Credential:
Phone: 715-273-4879