Healthcare Provider Details

I. General information

NPI: 1902952161
Provider Name (Legal Business Name): AREA AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8834 PLAINVIEW BLACKTOP
PLAINVIEW IL
62685-6577
US

IV. Provider business mailing address

8834 PLAINVIEW BLACKTOP
PLAINVIEW IL
62685-6577
US

V. Phone/Fax

Practice location:
  • Phone: 618-836-5992
  • Fax: 618-836-7709
Mailing address:
  • Phone: 618-836-5992
  • Fax: 618-836-7709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1769982
License Number StateIL

VIII. Authorized Official

Name: ELAINE MARIE GROTHAUS
Title or Position: SECRETARY TREASURER
Credential:
Phone: 618-836-5992