Provider Demographics
NPI:1194838862
Name:GLIDDEN AREA AMBULANCE, INC
Entity Type:Organization
Organization Name:GLIDDEN AREA AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-663-1131
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:GLIDDEN
Mailing Address - State:WI
Mailing Address - Zip Code:54527-0023
Mailing Address - Country:US
Mailing Address - Phone:715-663-1131
Mailing Address - Fax:
Practice Address - Street 1:23 N GRANT ST
Practice Address - Street 2:
Practice Address - City:GLIDDEN
Practice Address - State:WI
Practice Address - Zip Code:54527-7711
Practice Address - Country:US
Practice Address - Phone:715-663-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41336700Medicaid
WI41336700Medicaid
WI000085356Medicare PIN
WIP00180753Medicare PIN