MEDICARE: BARABOO DISTRICT AMBULANCE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154326692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARABOO DISTRICT AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	135 4TH ST
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-2184
Country	:	US
Telephone Number	:	608-356-3455
Fax Number	:	608-448-4703

Provider Business Practice Location Address
First Line	:	135 4TH ST
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-2184
Country	:	US
Telephone Number	:	608-356-3455
Fax Number	:	608-448-4703

Authorized Official
Title or Position	:	CHIEF / EMS DIRECTOR
Name	:	CALEB C JOHNSON
Credential	:
Telephone Number	:	608-393-1977

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	11/15/2021

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