Provider Demographics
NPI:1578684783
Name:SABULA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:SABULA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-687-2432
Mailing Address - Street 1:P. O. BOX 303
Mailing Address - Street 2:201 VULCAN STREET
Mailing Address - City:SABULA
Mailing Address - State:IA
Mailing Address - Zip Code:52070-0303
Mailing Address - Country:US
Mailing Address - Phone:563-687-2432
Mailing Address - Fax:563-687-2877
Practice Address - Street 1:201 VULCAN STREET
Practice Address - Street 2:
Practice Address - City:SABULA
Practice Address - State:IA
Practice Address - Zip Code:52070-0303
Practice Address - Country:US
Practice Address - Phone:563-687-2432
Practice Address - Fax:563-687-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2490400341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421728331001OtherILLINOIS DEPT HEALTHCARE
IA0064352Medicaid
IAP00432298OtherRAILROAD MEDICARE
IA21465OtherBLUE CROSS BLUE SHIELD IA
IA0064352Medicaid