Healthcare Provider Details

I. General information

NPI: 1942441241
Provider Name (Legal Business Name): ELITE AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22083 MARY DR
FRANKFORT IL
60423-8073
US

IV. Provider business mailing address

22083 MARY DR
FRANKFORT IL
60423-8073
US

V. Phone/Fax

Practice location:
  • Phone: 815-464-3021
  • Fax: 815-464-3021
Mailing address:
  • Phone: 815-464-3021
  • Fax: 815-464-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTI I VOGRIG
Title or Position: PRESIDENT
Credential:
Phone: 815-464-3021