Provider Demographics
NPI:1295788453
Name:OWEN-WITHEE COMMUNITY AMBULANCE SERVICE, INC.
Entity type:Organization
Organization Name:OWEN-WITHEE COMMUNITY AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-229-2652
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:OWEN
Mailing Address - State:WI
Mailing Address - Zip Code:54460-0036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:427 E 3RD ST
Practice Address - Street 2:
Practice Address - City:OWEN
Practice Address - State:WI
Practice Address - Zip Code:54460-9746
Practice Address - Country:US
Practice Address - Phone:715-229-2652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41325800Medicaid
WI0101OtherJOHN DEERE
000082662OtherADVOCARE MCHMO
1012423OtherPHYSICIAN'S PLUS
000082662OtherADVOCARE MCHMO
=========OtherTRICARE
WI0101OtherJOHN DEERE
000082662OtherADVOCARE MCHMO
=========OtherTRICARE