Healthcare Provider Details

I. General information

NPI: 1619019072
Provider Name (Legal Business Name): HEYWORTH AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S VINE ST
HEYWORTH IL
61745-0258
US

IV. Provider business mailing address

PO BOX 258 707 S VINE ST
HEYWORTH IL
61745-0258
US

V. Phone/Fax

Practice location:
  • Phone: 309-473-2149
  • Fax: 309-473-2473
Mailing address:
  • Phone: 309-473-2149
  • Fax: 309-473-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number26737
License Number StateIL

VIII. Authorized Official

Name: JUDY MOWERY
Title or Position: EMS CAPTAIN
Credential:
Phone: 309-261-3126