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General NPI Number Information
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NPI Number | 1801580543
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Entity Type | Organization
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Legal Business Name | CODE BLUE EMS LLC
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 207 W WALNUT ST
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City | TEUTOPOLIS
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State | IL
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Zip | 62467-1023
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Country | US
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Telephone | 217-663-3783
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Fax |
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Provider Business Mailing Address
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Address Line | 207 W WALNUT ST
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City | TEUTOPOLIS
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State | IL
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Zip | 62467-1023
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Country | US
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Telephone | 217-663-3783
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. STEVEN WAYNE GRAY JR.
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Credential | EMT-P
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Telephone | 217-663-3783
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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 |
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License Number State |
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