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General NPI Number Information
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NPI Number | 1083787428
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Entity Type | Organization
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Legal Business Name | WINCHESTER EMS
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 734 STATE HIGHWAY 106
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City | WINCHESTER
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State | IL
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Zip | 62694-1036
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Country | US
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Telephone | 217-742-3467
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Fax | 217-742-3733
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Provider Business Mailing Address
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Address Line | 734 STATE HIGHWAY 106 SOUTH PO BOX 122
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City | WINCHESTER
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State | IL
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Zip | 62694-1215
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Country | US
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Telephone | 217-742-3467
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Fax | 217-742-3733
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RANDY A DOLEN
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Credential |
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Telephone | 217-742-3467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 3096
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License Number State | IL
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