Provider Demographics
NPI:1235346297
Name:MINONG AREA FIRE AND AMBULANCE SERVICE
Entity Type:Organization
Organization Name:MINONG AREA FIRE AND AMBULANCE SERVICE
Other - Org Name:MINONG AREA AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLERK ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-466-2322
Mailing Address - Street 1:123 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MINONG
Mailing Address - State:WI
Mailing Address - Zip Code:54859-9541
Mailing Address - Country:US
Mailing Address - Phone:715-466-2322
Mailing Address - Fax:715-466-4752
Practice Address - Street 1:123 5TH AVE E
Practice Address - Street 2:
Practice Address - City:MINONG
Practice Address - State:WI
Practice Address - Zip Code:54859-9541
Practice Address - Country:US
Practice Address - Phone:715-466-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000164261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41332400Medicaid
WIP00149437Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI41332400Medicaid