Healthcare Provider Details

I. General information

NPI: 1437141413
Provider Name (Legal Business Name): OHANA AMBULANCE AND EMERGENCY MEDICAL SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 TERRACE DR
PORT WASHINGTON WI
53074-1181
US

IV. Provider business mailing address

PO BOX 606
PORT WASHINGTON WI
53074-0606
US

V. Phone/Fax

Practice location:
  • Phone: 262-689-0184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BALISTER
Title or Position: OWNER/OPERATOR
Credential:
Phone: 262-689-0184