Provider Demographics
NPI:1992008775
Name:DALLAS AREA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:DALLAS AREA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:715-455-2222
Mailing Address - Street 1:115 E BREWSTER ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE FARM
Mailing Address - State:WI
Mailing Address - Zip Code:54762-0122
Mailing Address - Country:US
Mailing Address - Phone:715-455-2222
Mailing Address - Fax:715-455-2223
Practice Address - Street 1:115 E BREWSTER ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE FARM
Practice Address - State:WI
Practice Address - Zip Code:54762-0122
Practice Address - Country:US
Practice Address - Phone:715-455-2222
Practice Address - Fax:715-455-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI600-11203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport