# SOUTHERN GREEN LAKE COUNTY AMBULANCE SERVICE

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

## Provider details

- **NPI number:** 1467668947
- **Authorized official:** LORI EVANS (SECRETARY-TREASURER)
- **Authorized official phone:** (920) 398-2636

## Contact information

- **Practice address:** 877 N. MARGARET STREET, MARKESAN, WI 53946-0075
- **Practice address phone:** (920) 398-2636
- **Mailing address:** 877 N. MARGARET STREET, MARKESAN, WI 53946-0075

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 60-00751 | WI | Yes |

## Other

- **Enumeration date:** 05/14/2007
- **Last updated:** 02/22/2012