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General NPI Number Information
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NPI Number | 1528106366
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Entity Type | Organization
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Legal Business Name | LEROY EMERGENCY AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 303 S EAST ST
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City | LE ROY
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State | IL
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Zip | 61752-1869
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Country | US
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Telephone | 309-962-6114
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Fax | 309-962-5054
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Provider Business Mailing Address
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Address Line | PO BOX 36
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City | LE ROY
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State | IL
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Zip | 61752-0036
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Country | US
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Telephone | 309-962-6114
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Fax | 309-962-5054
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LAURA WILLIS
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Credential |
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Telephone | 309-962-6114
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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 | 36734
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License Number State | IL
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