Healthcare Provider Details

I. General information

NPI: 1154455723
Provider Name (Legal Business Name): WYOMING AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MAIN
WYOMING IL
61491-0204
US

IV. Provider business mailing address

PO BOX 204 610 N MAIN ST
WYOMING IL
61491-0204
US

V. Phone/Fax

Practice location:
  • Phone: 309-695-5002
  • Fax:
Mailing address:
  • Phone: 309-695-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number22984
License Number State

VIII. Authorized Official

Name: ARDITH WITTMEYER
Title or Position: TREASURER
Credential:
Phone: 309-695-5933