Provider Demographics
NPI:1194863977
Name:VILLAGE OF NEW ATHENS
Entity Type:Organization
Organization Name:VILLAGE OF NEW ATHENS
Other - Org Name:NEW ATHENS AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VILLAGE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-475-2144
Mailing Address - Street 1:905 SPOTSYLVANIA STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ANTHENS
Mailing Address - State:IL
Mailing Address - Zip Code:62264-1569
Mailing Address - Country:US
Mailing Address - Phone:618-475-2144
Mailing Address - Fax:618-475-9269
Practice Address - Street 1:301 S. VAN BUREN ST.
Practice Address - Street 2:
Practice Address - City:NEW ANTHENS
Practice Address - State:IL
Practice Address - Zip Code:62264-1569
Practice Address - Country:US
Practice Address - Phone:618-475-3701
Practice Address - Fax:618-475-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4486702146N00000X
IL4486701146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL229370Medicare UPIN
229370Medicare UPIN
IL229370Medicare ID - Type Unspecified