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General NPI Number Information
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NPI Number | 1174513485
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Entity Type | Organization
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Legal Business Name | DECATUR AMBULANCE SERVICE, INC.
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 417 W WOOD ST
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City | DECATUR
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State | IL
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Zip | 62522-3109
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Country | US
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Telephone | 217-428-8641
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Fax | 217-362-5898
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Provider Business Mailing Address
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Address Line | 417 W WOOD ST
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City | DECATUR
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State | IL
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Zip | 62522-3109
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Country | US
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Telephone | 217-428-8641
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Fax | 217-362-5898
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Authorized Official
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Title or Position | VP-ADMINISTRATION
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Name | MR. DAVID A KRAUSE
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Credential |
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Telephone | 217-362-5931
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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 | 66510
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License Number State | IL
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