Provider Demographics
NPI:1144234576
Name:WARREN AREA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:WARREN AREA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-291-0007
Mailing Address - Street 1:103 W MAIN ST, PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:IL
Mailing Address - Zip Code:61087
Mailing Address - Country:US
Mailing Address - Phone:815-745-2841
Mailing Address - Fax:815-745-2841
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:IL
Practice Address - Zip Code:61087
Practice Address - Country:US
Practice Address - Phone:815-745-2841
Practice Address - Fax:815-745-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004370499OtherBCBS
IL0004370499OtherBCBS
IL601400Medicare PIN