MEDICARE: SHELBY AREA 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
1	341600000X	Ambulance	6-6710	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8721485	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1275537805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELBY AREA AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	310 N CEDAR ST
Second Line	:
City	:	SHELBYVILLE
State	:	IL
Zip	:	62565-1000
Country	:	US
Telephone Number	:	217-774-2608
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 N CEDAR ST
Second Line	:
City	:	SHELBYVILLE
State	:	IL
Zip	:	62565-1000
Country	:	US
Telephone Number	:	217-774-2608
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEANNE R COVENTRY
Credential	:	PA
Telephone Number	:	217-774-2608

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/22/2020

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Directions to “SHELBY AREA AMBULANCE SERVICE ” Practice Location

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