Provider Demographics
NPI:1396955860
Name:CHETEK AMBULANCE SERVICE
Entity type:Organization
Organization Name:CHETEK AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:715-924-4211
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:CHETEK
Mailing Address - State:WI
Mailing Address - Zip Code:54728-0047
Mailing Address - Country:US
Mailing Address - Phone:715-924-4211
Mailing Address - Fax:715-924-4695
Practice Address - Street 1:1224 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:CHETEK
Practice Address - State:WI
Practice Address - Zip Code:54728-0047
Practice Address - Country:US
Practice Address - Phone:715-924-4211
Practice Address - Fax:715-924-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60005713416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41355500Medicaid
WI41355500Medicaid