Provider Demographics
NPI:1457635674
Name:EDWARD AMBULANCE SERVICES LLC
Entity Type:Organization
Organization Name:EDWARD AMBULANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-304-6023
Mailing Address - Street 1:1701 QUINCY AVE
Mailing Address - Street 2:STE 13
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-3955
Mailing Address - Country:US
Mailing Address - Phone:630-548-1572
Mailing Address - Fax:
Practice Address - Street 1:1701 QUINCY AVE
Practice Address - Street 2:STE 13
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-3955
Practice Address - Country:US
Practice Address - Phone:630-548-1572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL088967341600000X, 3416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)