Southern Green Lake County Ambulance Service

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

60-00751 Issued in WI

Legal business name

SOUTHERN GREEN LAKE COUNTY AMBULANCE SERVICE

Practice address

877 N. Margaret Street
Markesan, WI 53946-0075

Phone

(920) 398-2636

NPI assigned

May 14, 2007

Organization subpart

No

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

Authorized official

Name

Lori Evans

Title

Secretary-Treasurer

Phone

(920) 398-2636

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329868800000",
    "number": "1467668947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 N. MARGARET STREET",
            "city": "MARKESAN",
            "state": "WI",
            "postal_code": "539460075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 N. MARGARET STREET",
            "city": "MARKESAN",
            "state": "WI",
            "postal_code": "539460075",
            "telephone_number": "920-398-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN GREEN LAKE COUNTY AMBULANCE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2012-02-22",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "SECRETARY-TREASURER",
        "authorized_official_telephone_number": "920-398-2636"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": "60-00751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "722414",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leesa Ann McShane, A.P.N.P.
• Charlotte Mertens, RN
• Paul A Miller, DDS
• Peggy Jean Post, COTA
• Nancy Lynn Schweder, R.N.
• Paula Ann Stout, P.T.A.
• Vandecastle Family Chiropractic Clinic,LLC
• Dawn Vandecastle, D.C.
• Lauren Walker, PHARMD, RPH
• Kathleen Suzanne Wilkowski, OT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.