Provider Demographics
NPI:1376506667
Name:SHULLSBURG AMBULANCE SERVICE
Entity Type:Organization
Organization Name:SHULLSBURG AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPILLANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-589-8850
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:190 JUDGEMENT STREET
Mailing Address - City:SHULLSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53586-0277
Mailing Address - Country:US
Mailing Address - Phone:608-965-3719
Mailing Address - Fax:
Practice Address - Street 1:190 NORTH JUDGEMENT STREET
Practice Address - Street 2:
Practice Address - City:SHULLSBURG
Practice Address - State:WI
Practice Address - Zip Code:53586-0277
Practice Address - Country:US
Practice Address - Phone:608-965-3719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41340100Medicaid