Provider Demographics
NPI:1417074840
Name:LOYAL UNIFIED FIRE & AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:LOYAL UNIFIED FIRE & AMBULANCE SERVICE INC
Other - Org Name:LOYAL AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SZYMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-255-8721
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:LOYAL
Mailing Address - State:WI
Mailing Address - Zip Code:54446-0175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W4325 STATE HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:LOYAL
Practice Address - State:WI
Practice Address - Zip Code:54446-8534
Practice Address - Country:US
Practice Address - Phone:715-255-8721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000482341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41316200Medicaid
WI41316200Medicaid