Provider Demographics
NPI:1962539627
Name:KENDALL AREA AMBULANCE SERVICE
Entity type:Organization
Organization Name:KENDALL AREA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-463-7124
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:219 W SOUTH RAILROAD STREET
Mailing Address - City:KENDALL
Mailing Address - State:WI
Mailing Address - Zip Code:54638-0216
Mailing Address - Country:US
Mailing Address - Phone:608-463-7124
Mailing Address - Fax:608-463-7237
Practice Address - Street 1:120 E SOUTH RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:KENDALL
Practice Address - State:WI
Practice Address - Zip Code:54638
Practice Address - Country:US
Practice Address - Phone:608-463-7124
Practice Address - Fax:608-463-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60944341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41340700Medicaid
WI88078Medicare ID - Type Unspecified