Provider Demographics
NPI:1013165901
Name:BIRCHWOOD FOUR CORNERS EMERGENCY SERVICES DISTRICT
Entity Type:Organization
Organization Name:BIRCHWOOD FOUR CORNERS EMERGENCY SERVICES DISTRICT
Other - Org Name:BIRCHWOOD AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-939-9174
Mailing Address - Street 1:216 MYRTLE ST W UNIT 231
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-3519
Mailing Address - Country:US
Mailing Address - Phone:651-261-4279
Mailing Address - Fax:888-680-4314
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BIRCHWOOD
Practice Address - State:WI
Practice Address - Zip Code:54817
Practice Address - Country:US
Practice Address - Phone:715-354-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000113341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance