MEDICARE: TOLEDO AREA EMERGENCY AMBULANCE SERVICE 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	66695	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01633002	OTHER	IL	BLUE CROSS BLUE SHIELD
2	590007102	OTHER	IL	PALMETTO GBA

General Provider Information

NPI Number	:	1609901883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOLEDO AREA EMERGENCY AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	PO BOX 516
Second Line	:	160 COURTHOUSE SQUARE
City	:	TOLEDO
State	:	IL
Zip	:	62468-0516
Country	:	US
Telephone Number	:	217-849-2065
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 COURTHOUSE SQUARE
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-0516
Country	:	US
Telephone Number	:	217-849-2065
Fax Number	:	217-849-2835

Authorized Official
Title or Position	:	EMS COORDINATOR
Name	:	DONNA WHITAKER
Credential	:
Telephone Number	:	217-849-2065

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	11/18/2008

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