MEDICARE: AMERICAN AMBULANCE COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	8586	IL

General Provider Information

NPI Number	:	1003162553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN AMBULANCE COMPANY

Provider Business Mailing Address
First Line	:	15941 HARLEM AVE
Second Line	:	NUM 126
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-1609
Country	:	US
Telephone Number	:	708-429-2082
Fax Number	:	708-357-3942

Provider Business Practice Location Address
First Line	:	15941 HARLEM AVE
Second Line	:	NUM 126
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-1609
Country	:	US
Telephone Number	:	708-429-2082
Fax Number	:	708-357-3942

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL JOSEPH ROGERS
Credential	:	EMT-P
Telephone Number	:	708-846-1433

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	08/01/2012

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