Healthcare Provider Details

I. General information

NPI: 1295788453
Provider Name (Legal Business Name): OWEN-WITHEE COMMUNITY AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 E 3RD ST
OWEN WI
54460-9746
US

IV. Provider business mailing address

PO BOX 36
OWEN WI
54460-0036
US

V. Phone/Fax

Practice location:
  • Phone: 715-229-2652
  • 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: RICK NELSON
Title or Position: EMS CHIEF
Credential:
Phone: 715-229-2652