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General NPI Number Information
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NPI Number | 1225346356
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Entity Type | Organization
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Legal Business Name | BLUE ANGELS EMS INC
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 402 N POPLAR ST
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City | CENTRALIA
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State | IL
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Zip | 62801-2965
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Country | US
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Telephone | 618-532-7777
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Fax | 618-532-7722
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Provider Business Mailing Address
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Address Line | 402 N POPLAR ST
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City | CENTRALIA
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State | IL
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Zip | 62801-2965
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Country | US
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Telephone | 877-446-5093
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Fax | 816-841-4689
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Authorized Official
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Title or Position | OWNER
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Name | MR. TODD WEISS
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Credential |
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Telephone | 618-532-7777
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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 | 9999
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License Number State | IL
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