1851412357 NPI number — CITY OF BEARDSTOWN

Table of content: (NPI 1851412357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851412357 NPI number — CITY OF BEARDSTOWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BEARDSTOWN
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:
CITY OF BEARDSTOWN 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:
1851412357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 W 3RD ST
Provider Second Line Business Mailing Address:
P.O. BOX 467
Provider Business Mailing Address City Name:
BEARDSTOWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62618-1142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-323-3110
Provider Business Mailing Address Fax Number:
217-323-4029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1119 EDWARDS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEARDSTOWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62618-1925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-323-1191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
V
Authorized Official Title or Position:
AMBULANCE BILLING CLERK
Authorized Official Telephone Number:
217-323-3110

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3452 , 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: 590007380 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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