Provider Demographics
NPI:1851386171
Name:VILLAGE OF WITTENBERG DBA WITTENBERG AREA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:VILLAGE OF WITTENBERG DBA WITTENBERG AREA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-793-3333
Mailing Address - Street 1:303 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOWLER
Mailing Address - State:WI
Mailing Address - Zip Code:54416-9704
Mailing Address - Country:US
Mailing Address - Phone:715-793-3333
Mailing Address - Fax:715-793-1313
Practice Address - Street 1:405 SOUTH WEBB STREET
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499
Practice Address - Country:US
Practice Address - Phone:715-253-3591
Practice Address - Fax:715-253-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-01357261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41353200Medicaid
WI41353200Medicaid