Provider Demographics
NPI:1114016888
Name:NOKOMIS-WITT AREA AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:NOKOMIS-WITT AREA AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOCQ
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:217-710-4485
Mailing Address - Street 1:120 N MAIN
Mailing Address - Street 2:PO BOX 523
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049
Mailing Address - Country:US
Mailing Address - Phone:217-532-9561
Mailing Address - Fax:217-532-9608
Practice Address - Street 1:10 BRANDON LANE
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:IL
Practice Address - Zip Code:62075
Practice Address - Country:US
Practice Address - Phone:217-563-7673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33614341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid