Provider Demographics
NPI:1265483218
Name:TOWN OF WINCHESTER
Entity Type:Organization
Organization Name:TOWN OF WINCHESTER
Other - Org Name:WINCHESTER VOLUNTEER AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROUSIL
Authorized Official - Suffix:
Authorized Official - Credentials:AMBULANCE DIRECTOR
Authorized Official - Phone:715-686-2123
Mailing Address - Street 1:10363 COUNTY RD W
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:WI
Mailing Address - Zip Code:54557
Mailing Address - Country:US
Mailing Address - Phone:715-686-2123
Mailing Address - Fax:715-686-2488
Practice Address - Street 1:10363 COUNTY RD W
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:WI
Practice Address - Zip Code:54557
Practice Address - Country:US
Practice Address - Phone:715-686-2123
Practice Address - Fax:715-686-2488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF WINCHESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41326500Medicaid
WI41326500Medicaid