Provider Demographics
NPI:1205180569
Name:BUNKER HILL AREA AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:BUNKER HILL AREA AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-585-2500
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62014-0309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 S WASHINGTON
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:IL
Practice Address - Zip Code:62014
Practice Address - Country:US
Practice Address - Phone:618-585-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043617146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty