Provider Demographics
NPI:1063494052
Name:CITY OF OLIN
Entity Type:Organization
Organization Name:CITY OF OLIN
Other - Org Name:OLIN AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF AMBULANCE BOARD
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-484-2139
Mailing Address - Street 1:2715 FRANK ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2593
Mailing Address - Country:US
Mailing Address - Phone:877-642-9543
Mailing Address - Fax:715-852-0620
Practice Address - Street 1:105 W CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:OLIN
Practice Address - State:IA
Practice Address - Zip Code:52320-9500
Practice Address - Country:US
Practice Address - Phone:319-484-2875
Practice Address - Fax:319-484-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25305003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0085860Medicaid
IA0085860Medicaid