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General NPI Number Information
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NPI Number | 1679550198
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Entity Type | Organization
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Legal Business Name | LEAMONS AMBULANCE SERVICE, INC
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 210 W MAIN ST
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City | LENA
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State | IL
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Zip | 61048-9770
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Country | US
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Telephone | 815-369-4512
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Fax | 815-369-2309
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Provider Business Mailing Address
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Address Line | 210 W MAIN ST
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City | LENA
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State | IL
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Zip | 61048-9770
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Country | US
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Telephone | 815-369-4512
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Fax | 815-369-2309
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Authorized Official
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Title or Position | OWNER
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Name | JACK P LEAMON
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Credential |
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Telephone | 815-369-4512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 1363
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License Number State | IL
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