Healthcare Provider Details

I. General information

NPI: 1841220688
Provider Name (Legal Business Name): COUNTY OF WHITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E CHERRY ST
CARMI IL
62821-1862
US

IV. Provider business mailing address

314 E CHERRY ST PO BOX 339
CARMI IL
62821-1862
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number5004
License Number StateIL

VIII. Authorized Official

Name: LANCE TROUSDALE
Title or Position: FIRE CHIEF
Credential:
Phone: 618-382-2604