Healthcare Provider Details

I. General information

NPI: 1295801751
Provider Name (Legal Business Name): SUTTON AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 N CLAY ST
TAYLORVILLE IL
62568-1801
US

IV. Provider business mailing address

PO BOX 457
WHEELING IL
60090-0457
US

V. Phone/Fax

Practice location:
  • Phone: 217-824-2275
  • Fax: 217-824-2451
Mailing address:
  • Phone: 847-577-8811
  • Fax: 847-577-3518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number3011
License Number StateIL

VIII. Authorized Official

Name: BETTY SUTTON
Title or Position: OWNER
Credential:
Phone: 217-824-2275