MEDICARE: ELLSWORTH AREA AMBULANCE SERVICE INC

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	396005590	OTHER		TRICARE
2	000082275	OTHER		ADVOCARE MCHMO
3	8182337	OTHER		MEDICA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	41307200	OTHER	WI	HIRSP
6	7002089	OTHER		PREFERRED ONE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609827997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLSWORTH AREA AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	PO BOX 718
Second Line	:
City	:	ELLSWORTH
State	:	WI
Zip	:	54011-0718
Country	:	US
Telephone Number	:
Fax Number	:	336-510-5894

Provider Business Practice Location Address
First Line	:	151 S PLUM ST
Second Line	:
City	:	ELLSWORTH
State	:	WI
Zip	:	54011-4137
Country	:	US
Telephone Number	:	715-273-4879
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DAN MORTH
Credential	:
Telephone Number	:	715-273-4879

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	05/21/2026

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