Provider Demographics
NPI:1881701258
Name:WAUNAKEE AREA EMERGENCY MEDICAL SERVICE
Entity type:Organization
Organization Name:WAUNAKEE AREA EMERGENCY MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAWLIKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-849-7522
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:201 N KLEIN DR
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-0033
Mailing Address - Country:US
Mailing Address - Phone:608-849-7522
Mailing Address - Fax:608-849-7583
Practice Address - Street 1:201 N KLEIN DR
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-1145
Practice Address - Country:US
Practice Address - Phone:608-849-7522
Practice Address - Fax:608-849-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60012213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41308800Medicaid
WI000082340Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER