Healthcare Provider Details

I. General information

NPI: 1093904393
Provider Name (Legal Business Name): NORTH LAND MUNICIPAL AMBULANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 S MAIN ST
LUCK WI
54853-9036
US

IV. Provider business mailing address

PO BOX 155 636 SOUTH MAIN ST
LUCK WI
54853-0155
US

V. Phone/Fax

Practice location:
  • Phone: 715-472-2388
  • Fax: 715-472-8411
Mailing address:
  • Phone: 715-472-2388
  • Fax: 715-472-8411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6001115
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6001122
License Number StateWI

VIII. Authorized Official

Name: MRS. RAEANN LOUISE ALLEN
Title or Position: MANAGER
Credential:
Phone: 715-472-2388