=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891781407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGGINS AMBULANCE SERVICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2005
-----------------------------------------------------
Last Update Date | 02/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 631 E GRAND AVE
-----------------------------------------------------
City | WISCONSIN RAPIDS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54494-4646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-423-4610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 631 E GRAND AVE
-----------------------------------------------------
City | WISCONSIN RAPIDS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54494-4646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-423-4610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SEC./TREAS.
-----------------------------------------------------
Name | MR. JAMES ARNOLD HIGGINS
-----------------------------------------------------
Credential | EMT-IV
-----------------------------------------------------
Telephone | 715-423-4610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 6001070
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------