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NPI Code Detail

MEDICARE: WYOMING AMBULANCE SERVICE

MEDICARE: WYOMING AMBULANCE SERVICE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13416L0300XLand Ambulance22984

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154455723
Entity Type Code : Organization
Provider Name (Legal Business Name) : WYOMING AMBULANCE SERVICE
Provider Business Mailing Address
First Line : PO BOX 204
Second Line : 610 N MAIN ST
City : WYOMING
State : IL
Zip : 61491-0204
Country : US
Telephone Number : 309-695-5002
Fax Number :
Provider Business Practice Location Address
First Line : 610 N MAIN
Second Line :
City : WYOMING
State : IL
Zip : 61491-0204
Country : US
Telephone Number : 309-695-5002
Fax Number :
Authorized Official
Title or Position : TREASURER
Name : ARDITH WITTMEYER
Credential :
Telephone Number : 309-695-5933
Provider Enumeration Date : 03/15/2007
Last Update Date : 08/22/2020

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Directions to “WYOMING AMBULANCE SERVICE ” Practice Location

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