Organization
SOUTHERN GREEN LAKE COUNTY AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI EVANS (SECRETARY-TREASURER)
(920) 398-2636
Entity
Organization
Contact information
Practice address
877 N. MARGARET STREET, MARKESAN, WI 53946-0075
(920) 398-2636
Mailing address
877 N. MARGARET STREET, MARKESAN, WI 53946-0075
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
60-00751
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
722414
—
WI
Enumeration date
05/14/2007
Last updated
02/22/2012
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