Provider Demographics
NPI:1407088578
Name:ALLIN TOWNSHIP AMBULANCE
Entity Type:Organization
Organization Name:ALLIN TOWNSHIP AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAZOEN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:309-379-2334
Mailing Address - Street 1:PO BOX 19
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61774-0019
Mailing Address - Country:US
Mailing Address - Phone:309-379-2334
Mailing Address - Fax:309-379-4341
Practice Address - Street 1:104 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:IL
Practice Address - Zip Code:61774-7540
Practice Address - Country:US
Practice Address - Phone:309-379-2334
Practice Address - Fax:309-379-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL026525341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance