=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225796303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RURAL POPE COUNTY EMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2021
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 EDDYVILLE BLACKTOP RD
-----------------------------------------------------
City | GOLCONDA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-683-2919
-----------------------------------------------------
Fax | 618-683-2922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 EDDYVILLE BLACKTOP RD
-----------------------------------------------------
City | GOLCONDA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-683-2919
-----------------------------------------------------
Fax | 618-683-2922
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/EMT
-----------------------------------------------------
Name | MRS. ANNE RENEE LIGHT
-----------------------------------------------------
Credential | EMT
-----------------------------------------------------
Telephone | 618-683-2919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------