MEDICARE: NEW LIFE AMBULANCE SERVICE INC.

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	3416L0300X	Land Ambulance	#8377	IL

General Provider Information

NPI Number	:	1336390004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE AMBULANCE SERVICE INC.

Provider Business Mailing Address
First Line	:	PO BOX 1096
Second Line	:
City	:	MAYWOOD
State	:	IL
Zip	:	60153-8096
Country	:	US
Telephone Number	:	708-345-2640
Fax Number	:	708-345-3774

Provider Business Practice Location Address
First Line	:	4936 W FLOURNOY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-5177
Country	:	US
Telephone Number	:	708-345-2640
Fax Number	:	708-345-3774

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. GORDON EGBUNA
Credential	:
Telephone Number	:	773-454-3392

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	11/16/2010

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