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General NPI Number Information
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NPI Number | 1306899430
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Entity Type | Organization
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Legal Business Name | MOUNT CALVARY AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 999 FOND DU LAC ST
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City | MOUNT CALVARY
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State | WI
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Zip | 53057-9772
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Country | US
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Telephone | 920-753-6086
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 88
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City | MOUNT CALVARY
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State | WI
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Zip | 53057-0088
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | STEPHANIE PFEIFER
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Credential |
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Telephone | 920-753-6086
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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 |
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License Number State |
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