Provider Demographics
NPI:1669488466
Name:OLIVIA AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:OLIVIA AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-579-0408
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-0097
Mailing Address - Country:US
Mailing Address - Phone:320-579-0408
Mailing Address - Fax:
Practice Address - Street 1:1005 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277
Practice Address - Country:US
Practice Address - Phone:320-523-5565
Practice Address - Fax:320-523-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01833416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN221267600Medicaid
MN040406002OtherPRIMEWEST
MN47193OLOtherBCBS