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General NPI Number Information
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NPI Number | 1033265939
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Entity Type | Organization
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Legal Business Name | MARSEILLES AREA AMBULANCE SERV INC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/16/2012
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Provider Practice Location Address
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Address Line | 207 LINCOLN ST
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City | MARSEILLES
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State | IL
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Zip | 61341-1904
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Country | US
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Telephone | 815-795-7387
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Fax | 815-795-3127
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Provider Business Mailing Address
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Address Line | PO BOX 260
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City | MENDOTA
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State | IL
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Zip | 61342-0260
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Country | US
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Telephone | 815-539-2468
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Fax | 815-539-6427
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Authorized Official
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Title or Position | EMS DIRECTOR
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Name | DON MODEEN
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Credential |
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Telephone | 815-795-7387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 2 2553
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License Number State | IL
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