# THERESA AMBULANCE SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104804657
- **Authorized official:** MR. KEVIN LESTER BAERWALD EMT (OPERATION MANAGER)
- **Authorized official phone:** (920) 488-6301

## Contact information

- **Practice address:** 302 DEPOT ROAD, THERESA, WI 53091
- **Practice address phone:** (920) 488-6301
- **Practice address fax:** (920) 488-6301
- **Mailing address:** PO BOX 275, THERESA, WI 53091-0275
- **Mailing address phone:** (920) 488-6301
- **Mailing address fax:** (920) 488-6301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 6000326 | WI | Yes |

## Other

- **Enumeration date:** 01/05/2006
- **Last updated:** 04/30/2012