Provider Demographics
NPI:1508048067
Name:KANSAS AMBULANCE CO
Entity Type:Organization
Organization Name:KANSAS AMBULANCE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-682-5280
Mailing Address - Street 1:202 N FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:KANSAS
Mailing Address - State:IL
Mailing Address - Zip Code:61933
Mailing Address - Country:US
Mailing Address - Phone:309-682-5280
Mailing Address - Fax:309-682-5327
Practice Address - Street 1:202 N FRONT STREET
Practice Address - Street 2:
Practice Address - City:KANSAS
Practice Address - State:IL
Practice Address - Zip Code:61933
Practice Address - Country:US
Practice Address - Phone:309-682-5280
Practice Address - Fax:309-682-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17464533416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002332003OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL0002332003OtherBLUE CROSS BLUE SHIELD