Healthcare Provider Details

I. General information

NPI: 1497753917
Provider Name (Legal Business Name): PRAIRIE EMERGENCY SERVICES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MADISON ST
JOLIET IL
60435-8200
US

IV. Provider business mailing address

PO BOX 635225
CINCINNATI OH
45263-0043
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-7133
  • Fax:
Mailing address:
  • Phone: 815-726-6860
  • Fax: 815-726-6861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: RAO KILARU
Title or Position: PRESIDENT
Credential: MD
Phone: 815-726-6860