=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770905390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN AMBULANCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2014
-----------------------------------------------------
Last Update Date | 01/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1559 ROUTE 34
-----------------------------------------------------
City | OSWEGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60543-8524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-476-2335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1559 ROUTE 34
-----------------------------------------------------
City | OSWEGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60543-8524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-476-2335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MUEEN ALMUSA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-636-9093
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 2620-01
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------