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General NPI Number Information
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NPI Number | 1669571337
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Entity Type | Organization
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Legal Business Name | CITY OF COLUMBIA
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 1020 N MAIN ST
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City | COLUMBIA
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State | IL
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Zip | 62236
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Country | US
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Telephone | 618-281-4163
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Fax | 618-281-6133
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Provider Business Mailing Address
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Address Line | PO BOX 467
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City | COLUMBIA
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State | IL
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Zip | 62236
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Country | US
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Telephone | 618-281-4163
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Fax | 618-281-6133
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Authorized Official
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Title or Position | ADMIN. ASSISTANT
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Name | SHANNON D BOUND
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Credential |
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Telephone | 618-281-4163
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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 | 4831
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 044152
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License Number State | IL
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