Healthcare Provider Details

I. General information

NPI: 1508236431
Provider Name (Legal Business Name): ERICKSON AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 W 190TH ST SUITE B-10
MOKENA IL
60448-5604
US

IV. Provider business mailing address

9850 W 190TH ST STE B-10
MOKENA IL
60448-5604
US

V. Phone/Fax

Practice location:
  • Phone: 708-995-1192
  • Fax:
Mailing address:
  • Phone: 708-995-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6000405
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateWI

VIII. Authorized Official

Name: CHRISTI VOGRIG
Title or Position: DIRECTOR OF PATIENT ACCOUNTS
Credential:
Phone: 708-995-1192