Provider Demographics
NPI:1609868090
Name:GOLD CROSS AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:GOLD CROSS AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMENESKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-450-2923
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0547
Mailing Address - Country:US
Mailing Address - Phone:734-224-4474
Mailing Address - Fax:336-791-0196
Practice Address - Street 1:1055 WITTMANN DR
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-3606
Practice Address - Country:US
Practice Address - Phone:920-727-3020
Practice Address - Fax:920-521-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41349400Medicaid