Healthcare Provider Details

I. General information

NPI: 1679550198
Provider Name (Legal Business Name): LEAMONS AMBULANCE SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W MAIN ST
LENA IL
61048-9770
US

IV. Provider business mailing address

210 W MAIN ST
LENA IL
61048-9770
US

V. Phone/Fax

Practice location:
  • Phone: 815-369-4512
  • Fax: 815-369-2309
Mailing address:
  • Phone: 815-369-4512
  • Fax: 815-369-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1363
License Number StateIL

VIII. Authorized Official

Name: JACK P LEAMON
Title or Position: OWNER
Credential:
Phone: 815-369-4512