Healthcare Provider Details

I. General information

NPI: 1245594522
Provider Name (Legal Business Name): SULLIVAN-PRESTIGE AMBULANCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2012
Last Update Date: 07/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N5214 N HELENVILLE RD
HELENVILLE WI
53137-9704
US

IV. Provider business mailing address

N5214 N HELENVILLE RD
HELENVILLE WI
53137-9704
US

V. Phone/Fax

Practice location:
  • Phone: 920-220-1019
  • Fax:
Mailing address:
  • Phone: 920-220-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberAPPLIED FOR
License Number StateWI

VIII. Authorized Official

Name: MRS. KIMBERLY KAY HEINE
Title or Position: PRESIDENT
Credential:
Phone: 920-220-1019