Healthcare Provider Details

I. General information

NPI: 1962839464
Provider Name (Legal Business Name): A-ADVANCE AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 W 190TH ST STE B-1
MOKENA IL
60448-5604
US

IV. Provider business mailing address

9850 W. 190 STREET SUITE B-7
MOKENA IL
60448-5606
US

V. Phone/Fax

Practice location:
  • Phone: 708-525-3173
  • Fax: 708-478-8653
Mailing address:
  • Phone: 708-525-3173
  • Fax: 773-774-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number8963
License Number StateIL

VIII. Authorized Official

Name: CHRISTI I VOGRIG-NICKS
Title or Position: DIRECTOR OF PATIENT ACCOUNTS
Credential:
Phone: 708-525-3173