Healthcare Provider Details

I. General information

NPI: 1588922793
Provider Name (Legal Business Name): COLES COUNTY SHUTTLE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14761 OLD STATE ROAD
CHARLESTON IL
61920-7662
US

IV. Provider business mailing address

14761 OLD STATE ROAD
CHARLESTON IL
61920-7662
US

V. Phone/Fax

Practice location:
  • Phone: 217-348-7074
  • Fax:
Mailing address:
  • Phone: 217-348-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. GINA WILEY
Title or Position: CLERICAL
Credential:
Phone: 217-348-7074