MEDICARE: AMBULANCE RESCUE 33 LTD.

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	022567	IL

General Provider Information

NPI Number	:	1336537885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULANCE RESCUE 33 LTD.

Provider Business Mailing Address
First Line	:	PO BOX 204
Second Line	:	1217 N SANTA FE
City	:	CHILLICOTHEE
State	:	IL
Zip	:	61523-1550
Country	:	US
Telephone Number	:	309-274-5507
Fax Number	:	309-274-5507

Provider Business Practice Location Address
First Line	:	1217 N SANTA FE AVE
Second Line	:
City	:	CHILLICOTHEE
State	:	IL
Zip	:	61523-1550
Country	:	US
Telephone Number	:	309-274-5507
Fax Number	:

Authorized Official
Title or Position	:	SECREATARY DELEGATED OFFICIAL
Name	:	MRS. TRACY L HEDDEN-SCHEELER
Credential	:
Telephone Number	:	309-648-6645

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	09/14/2015

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