Provider Demographics
NPI:1558555128
Name:COMMUNITY AMBULANCE
Entity Type:Organization
Organization Name:COMMUNITY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER/BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:OPIELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-276-6427
Mailing Address - Street 1:16003 VILLAGE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:WI
Mailing Address - Zip Code:54175-0092
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16003 VILLAGE VIEW RD
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:WI
Practice Address - Zip Code:54175-0092
Practice Address - Country:US
Practice Address - Phone:715-276-1613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41336200Medicaid
WI41336200Medicaid