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General NPI Number Information
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NPI Number | 1891240842
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Entity Type | Organization
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Legal Business Name | WHITE COUNTY AMBULANCE SERVICE
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 314 E CHERRY ST
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City | CARMI
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State | IL
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Zip | 62821-1853
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Country | US
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Telephone | 618-382-2604
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Fax | 618-384-4084
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | CARMI
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State | IL
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Zip | 62821-0339
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Country | US
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Telephone | 618-382-2406
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Fax | 618-384-4084
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Authorized Official
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Title or Position | EMT
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Name | TERESA K BROCK
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Credential |
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Telephone | 618-382-2604
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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 | EMS216070
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License Number State | IL
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