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General NPI Number Information
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NPI Number | 1740296219
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Entity Type | Organization
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Legal Business Name | POPE COUNTY VOLUNTEER AMBULANCE SERVICE
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 407 E MAIN ST
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City | GOLCONDA
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State | IL
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Zip | 62938
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Country | US
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Telephone | 618-683-2707
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Fax | 618-683-2707
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Provider Business Mailing Address
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Address Line | 407 E MAIN ST
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City | GOLCONDA
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State | IL
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Zip | 62938
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Country | US
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Telephone | 618-683-2707
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Fax | 618-683-2707
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. SABRINA D BANKS
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Credential | EMT PARAMEDIC
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Telephone | 618-683-2707
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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 | 501701
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License Number State | IL
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