Provider Demographics
NPI:1255468955
Name:MISHICOT AREA AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:MISHICOT AREA AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE CLERK
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:BYDALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-755-2525
Mailing Address - Street 1:511 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MISHICOT
Mailing Address - State:WI
Mailing Address - Zip Code:54228-0385
Mailing Address - Country:US
Mailing Address - Phone:920-755-2525
Mailing Address - Fax:920-755-2525
Practice Address - Street 1:511 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MISHICOT
Practice Address - State:WI
Practice Address - Zip Code:54228-0385
Practice Address - Country:US
Practice Address - Phone:920-755-2525
Practice Address - Fax:920-755-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6012343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41309700Medicaid
WI81-047Medicare ID - Type Unspecified