MEDICARE: MEDA-CARE AMBULANCE CORP

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	6000115	WI

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	:	1326025065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDA-CARE AMBULANCE CORP

Provider Business Mailing Address
First Line	:	4935 W FOREST HOME AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53219-4722
Country	:	US
Telephone Number	:	414-327-2880
Fax Number	:	414-327-1049

Provider Business Practice Location Address
First Line	:	2515 W VLIET ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1835
Country	:	US
Telephone Number	:	414-342-1148
Fax Number	:	414-342-0888

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	YVONNE S LARSEN
Credential	:
Telephone Number	:	414-327-2880

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	08/22/2020

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