Provider Demographics
NPI:1346475092
Name:CRESCENT-IROQUOIS EMS & AMBULANCE
Entity Type:Organization
Organization Name:CRESCENT-IROQUOIS EMS & AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-671-9849
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-3518
Practice Address - Street 1:104 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:IL
Practice Address - Zip Code:60928-8137
Practice Address - Country:US
Practice Address - Phone:815-671-9849
Practice Address - Fax:815-683-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL67733416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL614677500OtherDEPARTMENT OF LABOR
IL614677500OtherDEPARTMENT OF LABOR
IL=========OtherBCBS
IL=========001Medicaid
IL=========OtherBCBS