Basic Information
| Provider Information | |||||||||
| NPI: | 1013165901 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BIRCHWOOD FOUR CORNERS EMERGENCY SERVICES DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BIRCHWOOD AMBULANCE SERVICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 MYRTLE ST W UNIT 231 | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550823519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512614279 | ||||||||
| FaxNumber: | 8886804314 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BIRCHWOOD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153543003 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2008 | ||||||||
| LastUpdateDate: | 07/10/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FAIRCHILD | ||||||||
| AuthorizedOfficialFirstName: | VINCE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | AMBULANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7159399174 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 6000113 | WI | Y | Transportation Services | Ambulance |
No ID Information.