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General NPI Number Information
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NPI Number | 1699836379
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Entity Type | Organization
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Legal Business Name | PEORIA HOSPITAL'S MOBILE MEDICAL SERVICES
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 1718 N STERLING AVE
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City | PEORIA
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State | IL
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Zip | 61604-3831
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Country | US
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Telephone | 309-494-6215
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Fax | 309-494-6214
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Provider Business Mailing Address
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Address Line | 1718 N STERLING AVE
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City | PEORIA
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State | IL
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Zip | 61604-3831
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Country | US
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Telephone | 309-494-6215
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Fax | 309-494-6214
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ANDREW A RAND
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Credential |
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Telephone | 309-494-6215
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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 | 22592
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License Number State | IL
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