Provider Demographics
NPI:1679082226
Name:TRI-STATE REGIONAL AMBULANCE, INC.
Entity type:Organization
Organization Name:TRI-STATE REGIONAL AMBULANCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TORNSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-782-2282
Mailing Address - Street 1:235 CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-3119
Mailing Address - Country:US
Mailing Address - Phone:608-782-2282
Mailing Address - Fax:
Practice Address - Street 1:110 BRENDEL LANE
Practice Address - Street 2:SUITE B
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665
Practice Address - Country:US
Practice Address - Phone:608-637-8884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)