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

General Provider Information

NPI Number	:	1992008775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS AREA AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	115 E BREWSTER ST
Second Line	:
City	:	PRAIRIE FARM
State	:	WI
Zip	:	54762-0122
Country	:	US
Telephone Number	:	715-455-2222
Fax Number	:	715-455-2223

Provider Business Practice Location Address
First Line	:	115 E BREWSTER ST
Second Line	:
City	:	PRAIRIE FARM
State	:	WI
Zip	:	54762-0122
Country	:	US
Telephone Number	:	715-455-2222
Fax Number	:	715-455-2223

Authorized Official
Title or Position	:	DIRECTOR/TREASURER
Name	:	MRS. LINDA L AMBROSE
Credential	:	EMT
Telephone Number	:	715-455-2222

Provider Enumeration Date	:	12/16/2010
Last Update Date	:	10/14/2013

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