Healthcare Provider Details

I. General information

NPI: 1962659888
Provider Name (Legal Business Name): CARDINAL EMS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 N MAIN ST
BENTON IL
62812-1900
US

IV. Provider business mailing address

1624 N MAIN ST PO BOX 1117
BENTON IL
62812-1900
US

V. Phone/Fax

Practice location:
  • Phone: 618-439-0196
  • Fax: 618-439-7138
Mailing address:
  • Phone: 618-439-0196
  • Fax: 618-439-7138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIE A ROWLAND
Title or Position: PRESIDENT
Credential:
Phone: 618-439-0196