Provider Demographics
NPI:1083667596
Name:ELMWOOD AREA AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:ELMWOOD AREA AMBULANCE SERVICE INC
Other - Org Name:ELMWOOD AREA AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-639-2339
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54740-0234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:223 N WOODWORTH ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:WI
Practice Address - Zip Code:54740-8652
Practice Address - Country:US
Practice Address - Phone:715-639-2339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
000088688OtherADVOCARE MCHMO
WI41342700Medicaid
125164000OtherWORKER'S COMPENSATION
8181356OtherMEDICA
MN754407300Medicaid
=========017OtherBCBS
MN754407300Medicaid
WI41342700Medicaid
000088688OtherADVOCARE MCHMO