Plymouth Ambulance Service, Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

PLYMOUTH AMBULANCE SERVICE, INC

Practice address

604 South Milwaukee Street
Plymouth, WI 53073-2102

Phone

(920) 893-0588

Fax

(920) 892-8915

NPI assigned

Jun 6, 2006

Organization subpart

No

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

Authorized official

Name

Brian Goelzer, EMT-B

Title

Director of Operations

Phone

(920) 893-0588

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Plymouth Ambulance Service Doing business as

Locations

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345507200000",
    "number": "1740229582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 SOUTH MILWAUKEE STREET",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530732102",
            "telephone_number": "920-893-0588",
            "fax_number": "920-892-8915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 SOUTH MILWAUKEE STREET",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530732102",
            "telephone_number": "920-893-0588",
            "fax_number": "920-892-8915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH AMBULANCE SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2012-08-21",
        "status": "A",
        "authorized_official_last_name": "GOELZER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "920-893-0588",
        "authorized_official_credential": "EMT-B"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41314700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plymouth Ambulance Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tina Marie Ottman-Boykin, MSE LCSW LPC NCC
• Mauricio E Palencia, MD
• Christopher J Parker, PHARM D
• Sandra J Perronne, OT
• Scott R Peschke, MD
• Plymouth Care Center LLC
• Plymouth Chiropractic, SC
• Plymouth Family Physicians, S.C.
• Plymouth Joint School District
• Ashlyn Prisinger, PT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; 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.