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General NPI Number Information
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NPI Number | 1548375769
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Entity Type | Organization
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Legal Business Name | ANDALUSIA VOLUNTEER AMBULANCE
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 220 6TH AVE. W.
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City | ANDALUSIA
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State | IL
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Zip | 61232-0265
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Country | US
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Telephone | 309-798-5406
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Fax | 309-798-5406
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Provider Business Mailing Address
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Address Line | 220 6TH AVE. W. PO BOX 265
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City | ANDALUSIA
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State | IL
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Zip | 61232-0265
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Country | US
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Telephone | 309-798-5406
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Fax | 309-798-5406
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | CINDY CULLEN
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Credential |
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Telephone | 309-798-5406
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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 | 22560
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License Number State | IL
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