Provider Demographics
NPI:1033265939
Name:MARSEILLES AREA AMBULANCE SERV INC
Entity Type:Organization
Organization Name:MARSEILLES AREA AMBULANCE SERV INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:MODEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-795-7387
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-0260
Mailing Address - Country:US
Mailing Address - Phone:815-539-2468
Mailing Address - Fax:815-539-6427
Practice Address - Street 1:207 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341-1904
Practice Address - Country:US
Practice Address - Phone:815-795-7387
Practice Address - Fax:815-795-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2 2553341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005090010OtherBCBS
IL590128782OtherRAILROAD MEDICARE
215520300OtherDOL
IL590128782OtherRAILROAD MEDICARE
IL=========001Medicaid