Provider Demographics
NPI:1811034390
Name:BAYFIELD COMMUNITY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:BAYFIELD COMMUNITY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARYTREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-779-3356
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54814-0230
Mailing Address - Country:US
Mailing Address - Phone:715-779-3356
Mailing Address - Fax:
Practice Address - Street 1:813 WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:WI
Practice Address - Zip Code:54814-0230
Practice Address - Country:US
Practice Address - Phone:715-779-3356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-10213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41321400Medicaid
WI81601Medicare ID - Type Unspecified