Provider Demographics
NPI:1659466043
Name:WINONA AREA AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:WINONA AREA AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTORS-TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-457-4156
Mailing Address - Street 1:370 WEST 2ND STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987
Mailing Address - Country:US
Mailing Address - Phone:507-452-5351
Mailing Address - Fax:507-452-0764
Practice Address - Street 1:370 WEST 2ND STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987
Practice Address - Country:US
Practice Address - Phone:507-452-5351
Practice Address - Fax:507-452-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02723416L0300X
WI60013633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7G848WIOtherBLUE CROSS BLUE SHIELD
MN165217600Medicaid
WI41353600Medicaid
MN590000023Medicare ID - Type UnspecifiedMEDICARE