Theresa Ambulance Service

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

6000326 Issued in WI

Legal business name

THERESA AMBULANCE SERVICE

Practice address

302 Depot Road
Theresa, WI 53091

Phone

(920) 488-6301

Fax

(920) 488-6301

NPI assigned

Jan 5, 2006

Last updated

Apr 30, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kevin Lester Baerwald, EMT

Title

Operation Manager

Phone

(920) 488-6301

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1104804657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 275",
            "city": "THERESA",
            "state": "WI",
            "postal_code": "530910275",
            "telephone_number": "920-488-6301",
            "fax_number": "920-488-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 DEPOT ROAD",
            "city": "THERESA",
            "state": "WI",
            "postal_code": "53091",
            "telephone_number": "920-488-6301",
            "fax_number": "920-488-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERESA AMBULANCE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-05",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "BAERWALD",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "LESTER",
        "authorized_official_title_or_position": "OPERATION MANAGER",
        "authorized_official_telephone_number": "920-488-6301",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "EMT"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": "6000326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41328600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Creative Roots Counseling
• Brittany Sheree Hansen, RN
• Britney Laatsch
• James Peters, D.C.
• Stephanie Maria Stack

• Land Ambulance in Theresa, WI
• Providers in Theresa, WI by specialty
• Land Ambulance in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.