1396810180 NPI number — AOW AMBULANCE SERVICE INC. NFP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396810180 NPI number — AOW AMBULANCE SERVICE INC. NFP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AOW AMBULANCE SERVICE INC. NFP
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:
Provider Other Organization Name Type Code:
6
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:
1396810180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 443
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONEIDA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61467-0443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-368-6468
Provider Business Mailing Address Fax Number:
309-341-1945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 W. WILLARD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATAGA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61488-0443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-483-6365
Provider Business Practice Location Address Fax Number:
309-375-9260
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEENER
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
309-368-6468

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2549 , 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)





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