Healthcare Provider Details

I. General information

NPI: 1841287141
Provider Name (Legal Business Name): HIGHLAND AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 DODGEVILLE ST
HIGHLAND WI
53543-9293
US

IV. Provider business mailing address

709 DODGEVILLE ST
HIGHLAND WI
53543-9293
US

V. Phone/Fax

Practice location:
  • Phone: 608-929-4629
  • Fax:
Mailing address:
  • Phone: 608-929-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6001069
License Number StateWI

VIII. Authorized Official

Name: MRS. GRACE H. MIZE
Title or Position: BILLING SECRETARY
Credential:
Phone: 608-929-4629