Provider Demographics
NPI:1386634517
Name:COUNTY OF MONROE
Entity Type:Organization
Organization Name:COUNTY OF MONROE
Other - Org Name:MONROE COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-939-6175
Mailing Address - Street 1:901 ILLINOIS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1142
Mailing Address - Country:US
Mailing Address - Phone:618-939-6175
Mailing Address - Fax:
Practice Address - Street 1:901 ILLINOIS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1142
Practice Address - Country:US
Practice Address - Phone:618-939-6175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL44862341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance