Healthcare Provider Details

I. General information

NPI: 1376573345
Provider Name (Legal Business Name): BROWN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 ROUTE 24 WEST
MT STERLING IL
62353-9408
US

IV. Provider business mailing address

835 ROUTE 24 WEST
MT STERLING IL
62353-9408
US

V. Phone/Fax

Practice location:
  • Phone: 217-773-2113
  • Fax: 217-773-2090
Mailing address:
  • Phone: 217-773-2113
  • Fax: 217-773-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3454
License Number StateIL

VIII. Authorized Official

Name: MR. BRIAN JAMES GALLAHER I
Title or Position: AMBULANCE DIRECTOR
Credential: EMT-P
Phone: 217-773-2113