Provider Demographics
NPI:1083970537
Name:PEORIA COUNTY RURAL TRANSPORTATION
Entity Type:Organization
Organization Name:PEORIA COUNTY RURAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RURAL ECONOMIC DEVELOPMENT COORD.
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-495-4968
Mailing Address - Street 1:324 MAIN ST STE 501
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-2331
Mailing Address - Country:US
Mailing Address - Phone:309-495-4612
Mailing Address - Fax:309-495-4608
Practice Address - Street 1:324 MAIN ST STE 501
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-2331
Practice Address - Country:US
Practice Address - Phone:309-495-4612
Practice Address - Fax:309-495-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)