Healthcare Provider Details

I. General information

NPI: 1588141345
Provider Name (Legal Business Name): SUPERIOR AIR-GROUND AMBULANCE SERVICES OF WISCONSIN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N89W14452 PATRITA DR
MENOMONEE FALLS WI
53051-2359
US

IV. Provider business mailing address

395 W LAKE ST
ELMHURST IL
60126-1508
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-2000
  • Fax:
Mailing address:
  • Phone: 630-538-1887
  • Fax: 630-903-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMBERLY PATE GODDEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 630-903-2401