Provider Demographics
NPI:1831143429
Name:MERCER AREA AMBULANCE AND RESCUE INC
Entity Type:Organization
Organization Name:MERCER AREA AMBULANCE AND RESCUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-476-2056
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:WI
Mailing Address - Zip Code:54547-0409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5267 N VAUGHN ST
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:WI
Practice Address - Zip Code:54547-9320
Practice Address - Country:US
Practice Address - Phone:715-476-2056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41333300Medicaid
1012415OtherPHYSICIAN'S PLUS
MI184842370Medicaid
46301OtherNETWORK HEALTH
000083661OtherADVOCARE MCHMO
WI0101OtherJOHN DEERE
000083661OtherADVOCARE MCHMO
1012415OtherPHYSICIAN'S PLUS
P00281619Medicare ID - Type UnspecifiedRAILROAD MEDICARE
=========016OtherVALLEY HEALTH PLAN