Healthcare Provider Details

I. General information

NPI: 1528075850
Provider Name (Legal Business Name): HANOVER AMBULANCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FOX STREET
HANOVER IL
61041
US

IV. Provider business mailing address

3920 13TH AVE E SUITE 6
HIBBING MN
55746-3675
US

V. Phone/Fax

Practice location:
  • Phone: 815-591-3767
  • Fax:
Mailing address:
  • Phone: 218-263-7540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MARCIA HANSON
Title or Position: SECRETARY OF EMT
Credential:
Phone: 815-591-3767