MEDICARE: CRESCENT-IROQUOIS EMS & AMBULANCE

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	6773	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	614677500	OTHER	IL	DEPARTMENT OF LABOR

General Provider Information

NPI Number	:	1346475092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESCENT-IROQUOIS EMS & AMBULANCE

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:
City	:	WHEELING
State	:	IL
Zip	:	60090-0457
Country	:	US
Telephone Number	:	847-577-8811
Fax Number	:	847-577-3518

Provider Business Practice Location Address
First Line	:	104 N MAPLE ST
Second Line	:
City	:	CRESCENT CITY
State	:	IL
Zip	:	60928-8137
Country	:	US
Telephone Number	:	815-671-9849
Fax Number	:	815-683-2035

Authorized Official
Title or Position	:	CHIEF
Name	:	TIM MCCLAIN
Credential	:
Telephone Number	:	815-671-9849

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	03/07/2023

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Directions to “CRESCENT-IROQUOIS EMS & AMBULANCE ” Practice Location

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