MEDICARE: DALLAS AREA 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	600-1120	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	:	1386720159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS AREA AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	210 E NEWSOM ST
Second Line	:
City	:	PRAIRIE FARM
State	:	WI
Zip	:	54762-9714
Country	:	US
Telephone Number	:	715-455-1575
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 E NEWSOM ST
Second Line	:
City	:	PRAIRIE FARM
State	:	WI
Zip	:	54762-9714
Country	:	US
Telephone Number	:	715-455-1575
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. ARLENE ELIZABETH GULDVOG
Credential	:	EMT BASIC
Telephone Number	:	715-455-1575

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	06/18/2008

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Directions to “DALLAS AREA AMBULANCE SERVICE ” Practice Location

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