Healthcare Provider Details

I. General information

NPI: 1629176649
Provider Name (Legal Business Name): PARDEEVILLE DISTRICT AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GILLETTE ST
PARDEEVILLE WI
53954
US

IV. Provider business mailing address

PO BOX 396
PARDEEVILLE WI
53954-0396
US

V. Phone/Fax

Practice location:
  • Phone: 608-429-9089
  • Fax:
Mailing address:
  • Phone: 608-429-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number6001377
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: LINDA RAE HENNING
Title or Position: DIRECTOR
Credential: AEMT
Phone: 608-429-9089