1528106200 NPI number — ALHAMBRA AMBULANCE SERVICE FUND

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 1528106200 NPI number — ALHAMBRA AMBULANCE SERVICE FUND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALHAMBRA AMBULANCE SERVICE FUND
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:
ALHAMBRA - HAMEL 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:
1528106200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 OLD RTE 66 NORTH
Provider Second Line Business Mailing Address:
PO BX 261
Provider Business Mailing Address City Name:
HAMEL
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-633-2205
Provider Business Mailing Address Fax Number:
618-633-2110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 OLD RTE 66 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMEL
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-633-2205
Provider Business Practice Location Address Fax Number:
618-633-2110
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOGUE
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
618-633-2205

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  4 4821 , 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: 590155602 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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