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General NPI Number Information
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NPI Number | 1336233196
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Entity Type | Organization
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Legal Business Name | GALLATIN COUNTY AMBULANCE LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 204 BALTIMORE ST
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City | RIDGWAY
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State | IL
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Zip | 62979
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Country | US
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Telephone | 618-997-4915
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Fax | 618-993-3386
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Provider Business Mailing Address
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Address Line | 808 E DEYOUNG ST
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City | MARION
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State | IL
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Zip | 62959-3333
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Country | US
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Telephone | 618-997-4915
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Fax | 618-993-3386
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICK L COLYER
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Credential |
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Telephone | 618-997-4915
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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 | 5210
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License Number State | IL
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