Provider Demographics
NPI:1740231117
Name:OCONTO FALLS AREA JOINT AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:OCONTO FALLS AREA JOINT AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:AHLGRIM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CCT-P
Authorized Official - Phone:920-846-2662
Mailing Address - Street 1:831 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1241
Mailing Address - Country:US
Mailing Address - Phone:920-846-2662
Mailing Address - Fax:920-846-2676
Practice Address - Street 1:831 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1241
Practice Address - Country:US
Practice Address - Phone:920-846-2662
Practice Address - Fax:920-846-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41336300OtherHIRSP
MN0157163-00Medicaid
1012283OtherPHYSICIAN'S PLUS
WI41336300Medicaid
MI4631821Medicaid
2494OtherNETWORK HEALTH PLAN
396005559010OtherVALLEY HEALTH PLAN
BCBSOther396005559010
396005559010OtherMEDICARE BLUE MCHMO
000085332OtherADVOCARE MCHMO
IA0157163-00OtherMEDICAL ASSOCIATES HMO
WI0101OtherJOHN DEERE