Healthcare Provider Details

I. General information

NPI: 1730136391
Provider Name (Legal Business Name): SHAWANO AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N MAIN ST
SHAWANO WI
54166-2144
US

IV. Provider business mailing address

PO BOX 375
SHAWANO WI
54166-0375
US

V. Phone/Fax

Practice location:
  • Phone: 715-524-2036
  • Fax: 715-524-3292
Mailing address:
  • Phone: 715-524-2036
  • Fax: 715-524-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number6000338
License Number StateWI

VIII. Authorized Official

Name: PATRICK A. TRINKO
Title or Position: DIRECTOR
Credential:
Phone: 715-524-2036