Provider Demographics
NPI:1043319148
Name:COUNTY OF PULASKI
Entity Type:Organization
Organization Name:COUNTY OF PULASKI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-677-0185
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:IL
Mailing Address - Zip Code:62964-0052
Mailing Address - Country:US
Mailing Address - Phone:618-342-6209
Mailing Address - Fax:618-342-6254
Practice Address - Street 1:75 CAMO CLAD DR
Practice Address - Street 2:PULASKI COUNTY AMBULANCE
Practice Address - City:MOUNDS
Practice Address - State:IL
Practice Address - Zip Code:62964
Practice Address - Country:US
Practice Address - Phone:618-342-6209
Practice Address - Fax:618-342-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590000202OtherRAIL ROAD MEDICARE
IL07770390OtherBLUE CROSS BLUE SHIELD
IL371076724001Medicaid