MEDICARE: SAVANNA COMMUNITY AMBULANCE ASSOCIATION

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	1722903	IL

General Provider Information

NPI Number	:	1902944275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAVANNA COMMUNITY AMBULANCE ASSOCIATION

Provider Business Mailing Address
First Line	:	PO BOX 331
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074-0331
Country	:	US
Telephone Number	:	815-273-7002
Fax Number	:	815-273-3008

Provider Business Practice Location Address
First Line	:	827 CHICAGO AVE
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074-2217
Country	:	US
Telephone Number	:	815-273-7002
Fax Number	:	815-273-3008

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LOUISE BROUILLARD
Credential	:	EMT-PARAMEDIC
Telephone Number	:	815-273-7002

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	08/22/2020

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