Provider Demographics
NPI:1972793362
Name:RURAL MEDICAL AMBULANCE SERVICE
Entity Type:Organization
Organization Name:RURAL MEDICAL AMBULANCE SERVICE
Other - Org Name:RURAL MEDICAL AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-776-3687
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:129 W LOUISA STREET
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-0132
Mailing Address - Country:US
Mailing Address - Phone:608-776-3687
Mailing Address - Fax:
Practice Address - Street 1:129 W LOUISA ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1419
Practice Address - Country:US
Practice Address - Phone:608-776-3687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60012043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41309400Medicaid