Healthcare Provider Details

I. General information

NPI: 1184669822
Provider Name (Legal Business Name): GILLESPIE-BENLD AREA AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 CHARLES ST
GILLESPIE IL
62033-2117
US

IV. Provider business mailing address

208 CHARLES ST
GILLESPIE IL
62033-2117
US

V. Phone/Fax

Practice location:
  • Phone: 217-839-3032
  • Fax: 217-839-3053
Mailing address:
  • Phone: 217-839-3032
  • Fax: 217-839-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3010
License Number StateIL

VIII. Authorized Official

Name: MR. LAWRENCE P NORVILLE
Title or Position: BOARD PRESIDENT
Credential:
Phone: 217-839-3032