Provider Demographics
NPI:1306899794
Name:GREENWOOD AREA AMBULANCE SERV
Entity type:Organization
Organization Name:GREENWOOD AREA AMBULANCE SERV
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGOZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-267-7390
Mailing Address - Street 1:308 W SCHOFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54437-9473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 CANNERY ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:WI
Practice Address - Zip Code:54437-9705
Practice Address - Country:US
Practice Address - Phone:715-267-7390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41352100OtherHIRSP
000083928OtherTMG
WI0101OtherJOHN DEERE
000083928OtherADVOCARE MCHMO
2002697OtherPHYSICIAN'S PLUS
WI41332500Medicaid
2002697OtherPHYSICIAN'S PLUS
WI41352100OtherHIRSP
=========012OtherVALLEY HEALTH PLAN
WI41352100OtherHIRSP