Provider Demographics
NPI:1134298870
Name:MICHAEL W WILSON
Entity Type:Organization
Organization Name:MICHAEL W WILSON
Other - Org Name:ALLIANCE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-946-7226
Mailing Address - Street 1:115 E PEARL ST
Mailing Address - Street 2:
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-1310
Mailing Address - Country:US
Mailing Address - Phone:574-946-7226
Mailing Address - Fax:574-946-4141
Practice Address - Street 1:115 E PEARL ST
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-1310
Practice Address - Country:US
Practice Address - Phone:574-946-7226
Practice Address - Fax:574-946-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07863416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000217822OtherANTHEM BCBS
IN185060Medicare ID - Type UnspecifiedMEDICARE