Provider Demographics
NPI:1043414311
Name:MORRISONVILLE COMMUNITY AMBULANCE
Entity Type:Organization
Organization Name:MORRISONVILLE COMMUNITY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-643-4613
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62546-0641
Mailing Address - Country:US
Mailing Address - Phone:217-526-3199
Mailing Address - Fax:217-526-3192
Practice Address - Street 1:709 SARPY ST
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62546
Practice Address - Country:US
Practice Address - Phone:217-526-3199
Practice Address - Fax:217-526-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3071341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid