Provider Demographics
NPI:1093904393
Name:NORTH LAND MUNICIPAL AMBULANCE INC
Entity Type:Organization
Organization Name:NORTH LAND MUNICIPAL AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAEANN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-472-2388
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:636 SOUTH MAIN ST
Mailing Address - City:LUCK
Mailing Address - State:WI
Mailing Address - Zip Code:54853-0155
Mailing Address - Country:US
Mailing Address - Phone:715-472-2388
Mailing Address - Fax:715-472-8411
Practice Address - Street 1:636 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853-9036
Practice Address - Country:US
Practice Address - Phone:715-472-2388
Practice Address - Fax:715-472-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60011223416L0300X
WI60011153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41337700Medicaid