=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326093808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEPIN EMERGENCY AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 508 2ND ST
-----------------------------------------------------
City | PEPIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54759-7703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-442-2461
-----------------------------------------------------
Fax | 715-245-2399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 277
-----------------------------------------------------
City | PEPIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54759-0277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | TINA COOK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-442-2461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------