Organization
THERESA AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN LESTER BAERWALD EMT (OPERATION MANAGER)
(920) 488-6301
Entity
Organization
Contact information
Practice address
302 DEPOT ROAD, THERESA, WI 53091
(920) 488-6301
(920) 488-6301
Mailing address
PO BOX 275, THERESA, WI 53091-0275
(920) 488-6301
(920) 488-6301
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
6000326
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41328600
—
WI
Enumeration date
01/05/2006
Last updated
04/30/2012
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