=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174698799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUBURN AREA AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 06/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W WASHINGTON ST
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62615-1149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-523-3636
-----------------------------------------------------
Fax | 217-522-1404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 W WASHINGTON ST PO BOX 261
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62615-1149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-523-3636
-----------------------------------------------------
Fax | 217-522-1404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY,TREASURER
-----------------------------------------------------
Name | MR. DAVID HALLERBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-438-4091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 33640
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------