NPIMap

Individual provider Active NPI

David Sulik, MANAGER

  • Land Ambulance
  • Footville, WI
National Provider Identifier
1760602072
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
Practice address
252 N Gilbert St
Footville, WI 53537
Phone
(608) 876-6118
NPI assigned
Apr 27, 2007
Last updated
Nov 13, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X Primary

Addresses

Primary practice location

252 N Gilbert St
Footville, WI 53537

Mailing address

PO Box 72140
Cedarburg, WI 53012-7340
Phone (262) 375-9610

Other identifiers 1

IdentifierTypeStateIssuer
41350800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Footville Fire Dept & EMS Land Transport Past Accepting new patients
Footville EMS Service Land Transport Past Accepting new patients

Organizations & group practices 19

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194912000000",
    "number": "1760602072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 72140",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530127340",
            "telephone_number": "262-375-9610",
            "fax_number": "262-375-9608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "252 N GILBERT ST",
            "city": "FOOTVILLE",
            "state": "WI",
            "postal_code": "53537",
            "telephone_number": "608-876-6118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULIK",
        "first_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "MANAGER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-27",
        "last_updated": "2007-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41350800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Footville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.