Healthcare Provider Details

I. General information

NPI: 1891240842
Provider Name (Legal Business Name): WHITE COUNTY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E CHERRY ST
CARMI IL
62821-1853
US

IV. Provider business mailing address

PO BOX 339
CARMI IL
62821-0339
US

V. Phone/Fax

Practice location:
  • Phone: 618-382-2604
  • Fax: 618-384-4084
Mailing address:
  • Phone: 618-382-2406
  • Fax: 618-384-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberEMS216070
License Number StateIL

VIII. Authorized Official

Name: TERESA K BROCK
Title or Position: EMT
Credential:
Phone: 618-382-2604