Provider Demographics
NPI:1245594522
Name:SULLIVAN-PRESTIGE AMBULANCE, INC
Entity Type:Organization
Organization Name:SULLIVAN-PRESTIGE AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HEINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-220-1019
Mailing Address - Street 1:N5214 N HELENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HELENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53137-9704
Mailing Address - Country:US
Mailing Address - Phone:920-220-1019
Mailing Address - Fax:
Practice Address - Street 1:N5214 N HELENVILLE RD
Practice Address - Street 2:
Practice Address - City:HELENVILLE
Practice Address - State:WI
Practice Address - Zip Code:53137-9704
Practice Address - Country:US
Practice Address - Phone:920-220-1019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIAPPLIED FOR341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance