=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912020934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARION COUNTY AMBULANCE SERVICE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 S. WOOD ST. 207
-----------------------------------------------------
City | ODIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62870-1185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-775-8148
-----------------------------------------------------
Fax | 618-775-8149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 S. WOOD ST. P.O. BOX 207
-----------------------------------------------------
City | ODIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62870-1185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-775-8148
-----------------------------------------------------
Fax | 618-775-8149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. PAULA J ISAIAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-775-8148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------