Provider Demographics
NPI:1891747903
Name:BLOOMING GROVE, BURKE, MAPLE BLUFF EMS AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:BLOOMING GROVE, BURKE, MAPLE BLUFF EMS AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-244-3390
Mailing Address - Street 1:18 OXFORD PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5955
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 OXFORD PL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5955
Practice Address - Country:US
Practice Address - Phone:608-244-3390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41308700OtherWI CHRONIC DISEASE PROG
VNDR 531534OtherDEANCARE MAHMO
WI41308700Medicaid
WI41308700OtherHIRSP
1012155OtherPHYSICIAN'S PLUS
WI0101OtherJOHN DEERE
=========017OtherBCBS
WI41308700OtherWI CHRONIC DISEASE PROG
WI41308700OtherHIRSP