Tri-State Regional Ambulance, Inc.

Primary specialty

AmbulanceTaxonomy code 341600000X

Legal business name

TRI-STATE REGIONAL AMBULANCE, INC.

Practice address

122 S Illinois St
Prairie Du Chien, WI 53821-1638

Phone

(608) 782-2282

NPI assigned

Apr 4, 2007

Last updated

Mar 17, 2018By 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

Thomas Tornstrom

Title

Executive Director

Phone

(608) 782-2282

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA, WI2 enrollments

Enrollment records 2

Tax ID family

Gundersen Coulee Trails2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Tri-State Regional Ambulance, Inc.

  dba Gundersen Coulee Trails

  • Non-emergency Medical Transport (VAN)
  • Viroqua, WI
  • NPI 1679082226
  NPD tax ID

Locations

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1538281167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 CAUSEWAY BLVD",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546033119",
            "telephone_number": "608-519-3345",
            "fax_number": "608-782-4452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 S ILLINOIS ST",
            "city": "PRAIRIE DU CHIEN",
            "state": "WI",
            "postal_code": "538211638",
            "telephone_number": "608-782-2282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "402 Rickel St",
            "address_purpose": "LOCATION",
            "city": "West Union",
            "state": "IA",
            "postal_code": "521751069",
            "country_code": "US",
            "telephone_number": "608-782-2282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRI-STATE REGIONAL AMBULANCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "TORNSTROM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "608-782-2282"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41476300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulance in Prairie Du Chien, WI
• Providers in Prairie Du Chien, WI by specialty
• Ambulance in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.