Provider Demographics
NPI:1306846639
Name:STAUNTON AREA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:STAUNTON AREA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:618-635-3290
Mailing Address - Street 1:401 ASH ST
Mailing Address - Street 2:P.O. BOX 88
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-1295
Mailing Address - Country:US
Mailing Address - Phone:618-635-3290
Mailing Address - Fax:618-635-2711
Practice Address - Street 1:401 ASH ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-1295
Practice Address - Country:US
Practice Address - Phone:618-635-3290
Practice Address - Fax:618-635-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3 30153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL229210Medicare ID - Type Unspecified