Provider Demographics
NPI:1972791044
Name:MONDOVI AREA AMBULANCE COMMISSION
Entity Type:Organization
Organization Name:MONDOVI AREA AMBULANCE COMMISSION
Other - Org Name:MONDOVI AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ISAACSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-577-2320
Mailing Address - Street 1:156 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-1514
Mailing Address - Country:US
Mailing Address - Phone:715-926-3772
Mailing Address - Fax:
Practice Address - Street 1:156 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONDOVI
Practice Address - State:WI
Practice Address - Zip Code:54755-1514
Practice Address - Country:US
Practice Address - Phone:715-926-3772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-14
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60010873416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41323100Medicaid
82258Medicare UPIN