=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083667596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELMWOOD AREA AMBULANCE SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 01/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 223 N WOODWORTH ST
-----------------------------------------------------
City | ELMWOOD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54740-8652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-639-2339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 234
-----------------------------------------------------
City | ELMWOOD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54740-0234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | COLLIN GILLES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-577-3112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------