Provider Demographics
NPI:1851421226
Name:VILLAGE OF ONTARIO
Entity Type:Organization
Organization Name:VILLAGE OF ONTARIO
Other - Org Name:ONTARIO AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-797-4470
Mailing Address - Street 1:205 STATE ST.
Mailing Address - Street 2:P.O. BOX 138
Mailing Address - City:ONTARIO
Mailing Address - State:WI
Mailing Address - Zip Code:54651
Mailing Address - Country:US
Mailing Address - Phone:608-337-4381
Mailing Address - Fax:
Practice Address - Street 1:205 STATE ST.
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:WI
Practice Address - Zip Code:54651
Practice Address - Country:US
Practice Address - Phone:608-337-4381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE OF ONTARIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-001833416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41329300Medicaid
WI000083246Medicare ID - Type UnspecifiedPROVIDER #