Baraboo District Ambulance Service
Organization Active NPI Land Ambulance · Baraboo, WI
NPI 1154326692 · NPPES record last updated Nov 15, 2021
Key facts
- NPI
- 1154326692
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- BARABOO DISTRICT AMBULANCE SERVICE
- Practice address
- 135 4TH St
Baraboo, WI 53913-2184 - Phone
- (608) 356-3455
- Fax
- (608) 448-4703
- NPI assigned
- Jun 20, 2005
- Organization subpart
- No
Authorized official
- Name
- Caleb C Johnson
- Title
- Chief / EMS Director
- Phone
- (608) 393-1977
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0902234 | Baraboo District Ambulance Service | Certificate of waiver | Jun 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100129000337 | WI | Part B Supplier - Ambulance Service Supplier | 9436292430 | Practice locations: Baraboo, WI |
National Provider Directory
Locations
135 4th St
Baraboo, WI 53913
Phone (608) 356-3455
120 5th St
Baraboo, WI 53913
Phone (608) 356-3455
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
135 4TH St
Baraboo, WI 53913-2184
Mailing address
135 4TH St
Baraboo, WI 53913-2184
Phone (608) 356-3455
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41322600 | Medicaid | WI |
Other providers in Baraboo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.