Organization
GREAT DIVIDE AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROY BLOOM (SERVICE DIRECTOR)
(715) 798-3094
Entity
Organization
Contact information
Practice address
43555 US HIGHWAY 63, CABLE, WI 54821-2000
(715) 798-3094
(715) 798-4442
Mailing address
43555 US HIGHWAY 63, CABLE, WI 54821-2000
(715) 798-3094
(336) 510-5894
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
—
—
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
391913499019
BCBS
WI
05
—
41355200
—
WI
Enumeration date
08/15/2006
Last updated
09/16/2025
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