Provider Demographics
NPI:1003941139
Name:NORTHERN EDGAR COUNTY AMB SER
Entity Type:Organization
Organization Name:NORTHERN EDGAR COUNTY AMB SER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TRESURER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-269-3022
Mailing Address - Street 1:110 S IOWA
Mailing Address - Street 2:PO BOX 144
Mailing Address - City:CHRISMAN
Mailing Address - State:IL
Mailing Address - Zip Code:61924-0144
Mailing Address - Country:US
Mailing Address - Phone:217-269-3022
Mailing Address - Fax:217-269-2348
Practice Address - Street 1:110 S IOWA
Practice Address - Street 2:
Practice Address - City:CHRISMAN
Practice Address - State:IL
Practice Address - Zip Code:61924-0144
Practice Address - Country:US
Practice Address - Phone:217-269-3022
Practice Address - Fax:217-269-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6533013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2332001OtherBLUE CROSS BLUE SHIELD
IL2332001OtherBLUE CROSS BLUE SHIELD
IL2332001OtherBLUE CROSS BLUE SHIELD