Provider Demographics
NPI:1225346356
Name:BLUE ANGELS EMS INC
Entity Type:Organization
Organization Name:BLUE ANGELS EMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-532-7777
Mailing Address - Street 1:402 N POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-2965
Mailing Address - Country:US
Mailing Address - Phone:877-446-5093
Mailing Address - Fax:816-841-4689
Practice Address - Street 1:402 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-2965
Practice Address - Country:US
Practice Address - Phone:618-532-7777
Practice Address - Fax:618-532-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL99993416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport