Provider Demographics
NPI:1154326692
Name:BARABOO DISTRICT AMBULANCE SERVICE
Entity Type:Organization
Organization Name:BARABOO DISTRICT AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF / EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-393-1977
Mailing Address - Street 1:135 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2184
Mailing Address - Country:US
Mailing Address - Phone:608-356-3455
Mailing Address - Fax:608-448-4703
Practice Address - Street 1:135 4TH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-2184
Practice Address - Country:US
Practice Address - Phone:608-356-3455
Practice Address - Fax:608-448-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41322600Medicaid