Provider Demographics
NPI:1558346957
Name:GREENLEAF AMBULANCE SERVICE
Entity Type:Organization
Organization Name:GREENLEAF AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILTGEN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:785-747-2858
Mailing Address - Street 1:507 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:GREENLEAF
Mailing Address - State:KS
Mailing Address - Zip Code:66943
Mailing Address - Country:US
Mailing Address - Phone:785-747-2858
Mailing Address - Fax:785-747-2212
Practice Address - Street 1:507 5TH STREET
Practice Address - Street 2:
Practice Address - City:GREENLEAF
Practice Address - State:KS
Practice Address - Zip Code:66943
Practice Address - Country:US
Practice Address - Phone:785-747-2858
Practice Address - Fax:785-747-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119984OtherBCBS
KS119984OtherBCBS