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General NPI Number Information
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NPI Number | 1255468955
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Entity Type | Organization
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Legal Business Name | MISHICOT AREA AMBULANCE SERVICE, INC.
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 214 SOUTH MAIN STREET
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City | MISHICOT
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State | WI
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Zip | 54228
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Country | US
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Telephone | 920-255-4235
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Fax | 920-755-2345
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Provider Business Mailing Address
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Address Line | PO BOX 214
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City | MISHICOT
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State | WI
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Zip | 54228-0214
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Country | US
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Telephone | 920-255-4235
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Fax | 920-755-2345
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Authorized Official
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Title or Position | SERVICE DIRECTOR
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Name | KRISTY E REYNOLDS
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Credential |
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Telephone | 920-255-4235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 601234
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License Number State | WI
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