Active NPI
Mount Calvary Ambulance Service Inc
- Land Ambulance
- Mount Calvary, WI
National Provider Identifier
1306899430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- MOUNT CALVARY AMBULANCE SERVICE INC
- Practice address
- 999 Fond Du Lac St
Mount Calvary, WI 53057-9772 - Phone
- (920) 753-6086
- NPI assigned
- May 18, 2006
- Last updated
- Oct 9, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stephanie Pfeifer
- Title
- Administrator
- Phone
- (920) 753-6086
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | NU | Primary |
Addresses
Primary practice location
999 Fond Du Lac St
Mount Calvary, WI 53057-9772
Mailing address
PO Box 88
Mount Calvary, WI 53057-0088
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11518 | Other | NETWORK HEALTH PLAN | |
| 41328000 | Medicaid | WI | |
| 11518 | Other | HERITAGE NATIONAL | |
| 41328000 | Other | WI | HIRSP |
| 000081003 | Other | ADVOCARE MCHMO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040927000531 | WI | Part B Supplier - Ambulance Service Supplier | 3870562911 | Practice locations: Mount Calvary, WI |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1349740800000",
"number": "1306899430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 88",
"city": "MOUNT CALVARY",
"state": "WI",
"postal_code": "530570088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "999 FOND DU LAC ST",
"city": "MOUNT CALVARY",
"state": "WI",
"postal_code": "530579772",
"telephone_number": "920-753-6086"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOUNT CALVARY AMBULANCE SERVICE INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-18",
"last_updated": "2012-10-09",
"status": "A",
"authorized_official_last_name": "PFEIFER",
"authorized_official_first_name": "STEPHANIE",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "920-753-6086"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH PLAN",
"identifier": "11518",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41328000",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HERITAGE NATIONAL",
"identifier": "11518",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIRSP",
"identifier": "41328000",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADVOCARE MCHMO",
"identifier": "000081003",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Calvary, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.