Provider Demographics
NPI:1295765907
Name:WAUPACA AREA AMBULANCE, LTD.
Entity type:Organization
Organization Name:WAUPACA AREA AMBULANCE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PORREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-258-8103
Mailing Address - Street 1:500 COUNTY ROAD K
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2300
Mailing Address - Country:US
Mailing Address - Phone:715-258-8103
Mailing Address - Fax:715-258-8879
Practice Address - Street 1:500 COUNTY ROAD K
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2300
Practice Address - Country:US
Practice Address - Phone:715-258-8103
Practice Address - Fax:715-258-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000288146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41316100Medicaid