Provider Demographics
NPI:1063579381
Name:AEGIS GROUP INC
Entity type:Organization
Organization Name:AEGIS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-469-9779
Mailing Address - Street 1:1765 ALLOUEZ AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5645
Mailing Address - Country:US
Mailing Address - Phone:920-469-9779
Mailing Address - Fax:920-469-9777
Practice Address - Street 1:1765 ALLOUEZ AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5645
Practice Address - Country:US
Practice Address - Phone:920-469-9779
Practice Address - Fax:920-469-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001266341600000X, 3416A0800X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4755776 TYPE 18Medicaid
MI4755794 TYPE 18Medicaid
WI41312700Medicaid
WI590001468OtherRR MEDICARE AIR AMBULANCE
WI41357800Medicaid
WI590001468OtherRR MEDICARE GROUND AMBULA
MI4755776 TYPE 18Medicaid
MI4755794 TYPE 18Medicaid