Provider Demographics
NPI:1013954239
Name:ANDRESEN AMBULANCE, LLC
Entity Type:Organization
Organization Name:ANDRESEN AMBULANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-647-6075
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-9515
Practice Address - Street 1:85 E ROBB RD
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-9201
Practice Address - Country:US
Practice Address - Phone:608-647-6075
Practice Address - Fax:877-344-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6603155341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00270526OtherMEDICARE RAILROAD
WI41360900Medicaid
WIP00270526OtherMEDICARE RAILROAD