Tri-State Regional Ambulance, Inc.

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Legal business name

TRI-STATE REGIONAL AMBULANCE, INC.

Doing business as

Gundersen Coulee Trails

Practice address

110 Brendel Lane
Suite B
Viroqua, WI 54665

Phone

(608) 637-8884

NPI assigned

Sep 27, 2017

Last updated

Sep 27, 2017By 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 names 1

• Gundersen Coulee Trails Doing business as

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.

  • Ambulance
  • Prairie Du Chien, WI
  • NPI 1538281167
  NPD tax ID

Locations

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

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506470400000",
    "number": "1679082226",
    "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": "608-782-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BRENDEL LANE",
            "address_2": "SUITE B",
            "city": "VIROQUA",
            "state": "WI",
            "postal_code": "54665",
            "telephone_number": "608-637-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE REGIONAL AMBULANCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-27",
        "last_updated": "2017-09-27",
        "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": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gundersen Coulee Trails",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Non-emergency Medical Transport (VAN) in Viroqua, WI
• Providers in Viroqua, WI by specialty
• Non-emergency Medical Transport (VAN) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.