Healthcare Provider Details

I. General information

NPI: 1912020934
Provider Name (Legal Business Name): MARION COUNTY AMBULANCE SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S. WOOD ST. 207
ODIN IL
62870-1185
US

IV. Provider business mailing address

110 S. WOOD ST. P.O. BOX 207
ODIN IL
62870-1185
US

V. Phone/Fax

Practice location:
  • Phone: 618-775-8148
  • Fax: 618-775-8149
Mailing address:
  • Phone: 618-775-8148
  • Fax: 618-775-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. PAULA J ISAIAH
Title or Position: OWNER
Credential:
Phone: 618-775-8148