Healthcare Provider Details

I. General information

NPI: 1033265939
Provider Name (Legal Business Name): MARSEILLES AREA AMBULANCE SERV INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 LINCOLN ST
MARSEILLES IL
61341-1904
US

IV. Provider business mailing address

PO BOX 260
MENDOTA IL
61342-0260
US

V. Phone/Fax

Practice location:
  • Phone: 815-795-7387
  • Fax: 815-795-3127
Mailing address:
  • Phone: 815-539-2468
  • Fax: 815-539-6427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2 2553
License Number StateIL

VIII. Authorized Official

Name: DON MODEEN
Title or Position: EMS DIRECTOR
Credential:
Phone: 815-795-7387