MEDICARE: LEAMONS 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	341600000X	Ambulance	1363	IL

General Provider Information

NPI Number	:	1679550198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAMONS AMBULANCE SERVICE, INC

Provider Business Mailing Address
First Line	:	210 W MAIN ST
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-9770
Country	:	US
Telephone Number	:	815-369-4512
Fax Number	:	815-369-2309

Provider Business Practice Location Address
First Line	:	210 W MAIN ST
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-9770
Country	:	US
Telephone Number	:	815-369-4512
Fax Number	:	815-369-2309

Authorized Official
Title or Position	:	OWNER
Name	:	JACK P LEAMON
Credential	:
Telephone Number	:	815-369-4512

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	04/03/2012

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