MEDICARE: FARMER CITY AMBULANCE SRVC INC

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	3416L0300X	Land Ambulance		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02071191	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1275674640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMER CITY AMBULANCE SRVC INC

Provider Business Mailing Address
First Line	:	105 S MAIN STREET
Second Line	:
City	:	FARMER CITY
State	:	IL
Zip	:	61842-1453
Country	:	US
Telephone Number	:	309-928-2111
Fax Number	:	309-928-3218

Provider Business Practice Location Address
First Line	:	105 S MAIN STREET
Second Line	:
City	:	FARMER CITY
State	:	IL
Zip	:	61842-1453
Country	:	US
Telephone Number	:	309-928-2111
Fax Number	:	309-928-3218

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SHARON STIGER
Credential	:
Telephone Number	:	309-928-2111

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	04/20/2008

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