1770634438 NPI number — NORTHWESTERN AREA AMBULANCE RESCUE SERVICE, INC

Table of content: (NPI 1770634438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770634438 NPI number — NORTHWESTERN AREA AMBULANCE RESCUE SERVICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWESTERN AREA AMBULANCE RESCUE 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:
1770634438
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:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-577-8811
Provider Business Mailing Address Fax Number:
847-577-3518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 E STATE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMYRA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-436-2015
Provider Business Practice Location Address Fax Number:
217-436-2015
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LUTTERL
Authorized Official First Name:
GENE
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
217-436-2015

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3435 , 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: 5932014 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com