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General NPI Number Information
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NPI Number | 1902973969
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Entity Type | Organization
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Legal Business Name | COUNTY OF COLES
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 06/14/2013
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Provider Practice Location Address
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Address Line | 520 JACKSON AVE
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City | CHARLESTON
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State | IL
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Zip | 61920-2030
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Country | US
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Telephone | 217-345-8425
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Fax | 217-345-8427
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Provider Business Mailing Address
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Address Line | 520 JACKSON AVE
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City | CHARLESTON
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State | IL
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Zip | 61920-2030
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Country | US
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Telephone | 217-345-8425
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Fax | 217-345-8427
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Authorized Official
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Title or Position | COMPTROLLER
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Name | HEATHER E KUYKENDALL
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Credential |
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Telephone | 217-345-8425
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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 | 1746456
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1746458
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1746457
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License Number State | IL
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