Provider Demographics
NPI:1083787428
Name:WINCHESTER EMS
Entity Type:Organization
Organization Name:WINCHESTER EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-742-3467
Mailing Address - Street 1:734 STATE HIGHWAY 106 SOUTH
Mailing Address - Street 2:PO BOX 122
Mailing Address - City:WINCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62694-1215
Mailing Address - Country:US
Mailing Address - Phone:217-742-3467
Mailing Address - Fax:217-742-3733
Practice Address - Street 1:734 STATE HIGHWAY 106
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62694-1036
Practice Address - Country:US
Practice Address - Phone:217-742-3467
Practice Address - Fax:217-742-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30963416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL545780Medicare PIN