Provider Demographics
NPI:1194828095
Name:GORDON-WASCOTT EMS
Entity type:Organization
Organization Name:GORDON-WASCOTT EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-376-2640
Mailing Address - Street 1:14511 S HWY 53
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:WI
Mailing Address - Zip Code:53838-4800
Mailing Address - Country:US
Mailing Address - Phone:715-376-2640
Mailing Address - Fax:866-732-0699
Practice Address - Street 1:14511 S HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:WI
Practice Address - Zip Code:54838-4800
Practice Address - Country:US
Practice Address - Phone:715-376-2640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41326900Medicaid
WI=========012OtherBCBS
WI=========012OtherBCBS
WIP00181458Medicare PIN