1619056538 NPI number — AMERICA AMBULANCE SERVICE, INC.

Table of content: (NPI 1619056538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619056538 NPI number — AMERICA AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICA AMBULANCE SERVICE, INC.
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:
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:
1619056538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2711 W. WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62702-3466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-523-3636
Provider Business Mailing Address Fax Number:
217-522-1404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1511 S 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62703-2806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-523-3636
Provider Business Practice Location Address Fax Number:
217-544-1404
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZAPPA
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
217-523-3636

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  33605 , 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: 590128389 . This is a "PALMETTO GBA RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 002186 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 08490004 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0075620 . This is a "UNTD MINE WORKERS OF AM" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 31750 . This is a "PRSNL CARE INS OF IL INC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com