Provider Demographics
NPI:1376573345
Name:BROWN COUNTY
Entity Type:Organization
Organization Name:BROWN COUNTY
Other - Org Name:BROWN COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GALLAHER
Authorized Official - Suffix:I
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:217-773-2113
Mailing Address - Street 1:835 ROUTE 24 WEST
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:62353-9408
Mailing Address - Country:US
Mailing Address - Phone:217-773-2113
Mailing Address - Fax:217-773-2090
Practice Address - Street 1:835 ROUTE 24 WEST
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:IL
Practice Address - Zip Code:62353-9408
Practice Address - Country:US
Practice Address - Phone:217-773-2113
Practice Address - Fax:217-773-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL34543416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL570871OtherBLUE CROSS BLUE SHIELD
ILP00124502OtherRAILROAD MEDICARE
IL590007560OtherRAILROAD MEDICARE
IL376000422001Medicaid
ILP00124502OtherRAILROAD MEDICARE