1376573345 NPI number — BROWN COUNTY

Table of content: (NPI 1376573345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376573345 NPI number — BROWN COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWN COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BROWN COUNTY AMBULANCE SERVICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376573345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 ROUTE 24 WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT STERLING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62353-9408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-773-2113
Provider Business Mailing Address Fax Number:
217-773-2090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 ROUTE 24 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT STERLING
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62353-9408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-773-2113
Provider Business Practice Location Address Fax Number:
217-773-2090
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALLAHER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
AMBULANCE DIRECTOR
Authorized Official Telephone Number:
217-773-2113

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3454 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 570871 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00124502 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 590007560 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 376000422001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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