Provider Demographics
NPI:1659402600
Name:TRI-STATE AMBULANCE, INC.
Entity type:Organization
Organization Name:TRI-STATE AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOM
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:608-782-4522
Practice Address - Street 1:235 CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-3119
Practice Address - Country:US
Practice Address - Phone:608-782-2282
Practice Address - Fax:608-782-4522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60113533416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0554113Medicaid
WI41359100Medicaid
MN263067200Medicaid