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General NPI Number Information
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NPI Number | 1437141413
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Entity Type | Organization
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Legal Business Name | OHANA AMBULANCE AND EMERGENCY MEDICAL SERVICE LLC
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 1885 TERRACE DR
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-1181
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Country | US
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Telephone | 262-689-0184
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 606
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-0606
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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 | OWNER/OPERATOR
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Name | DAVID BALISTER
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Credential |
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Telephone | 262-689-0184
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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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Taxonomy #2
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Taxonomy Code | 146M00000X
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Taxonomy Name | Intermediate Emergency Medical Technician
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License Number |
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License Number State |
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