Provider Demographics
NPI:1275537805
Name:SHELBY AREA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:SHELBY AREA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COVENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:217-774-2608
Mailing Address - Street 1:310 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-1000
Mailing Address - Country:US
Mailing Address - Phone:217-774-2608
Mailing Address - Fax:
Practice Address - Street 1:310 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1000
Practice Address - Country:US
Practice Address - Phone:217-774-2608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6-6710341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8721485OtherBCBSIL
IL8721485OtherBCBSIL
IL8721485OtherBCBSIL