Provider Demographics
NPI:1639244601
Name:ERICKSON-NELSON SERVICES, INC
Entity Type:Organization
Organization Name:ERICKSON-NELSON SERVICES, INC
Other - Org Name:ERICKSON AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-632-5412
Mailing Address - Street 1:826 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1339
Mailing Address - Country:US
Mailing Address - Phone:262-632-5412
Mailing Address - Fax:262-632-0532
Practice Address - Street 1:826 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1339
Practice Address - Country:US
Practice Address - Phone:262-632-5412
Practice Address - Fax:262-632-0532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERICKSON-NELSON SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-22
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000405341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41320700Medicaid
WI590094171Medicare PIN
WI41320700Medicaid