MEDICARE: NEW BOSTON VOLUNTEER 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	22540
2	3416L0300X	Land Ambulance	22540	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06632003	OTHER	IL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881728459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BOSTON VOLUNTEER AMBULANCE SERVICE, INC

Provider Business Mailing Address
First Line	:	209 WASHINGTON
Second Line	:
City	:	NEW BOSTON
State	:	IL
Zip	:	61272-0066
Country	:	US
Telephone Number	:	309-587-8213
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 BROADWAY
Second Line	:
City	:	NEW BOSTON
State	:	IL
Zip	:	61272-0066
Country	:	US
Telephone Number	:	309-587-8213
Fax Number	:	309-587-2029

Authorized Official
Title or Position	:	SECRETARY/TREASURER
Name	:	DONALD E BACON
Credential	:
Telephone Number	:	309-587-8213

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	12/29/2011

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Directions to “NEW BOSTON VOLUNTEER AMBULANCE SERVICE, INC ” Practice Location

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