Provider Demographics
NPI:1619056538
Name:AMERICA AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:AMERICA AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:217-523-3636
Mailing Address - Street 1:2711 W. WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-3466
Mailing Address - Country:US
Mailing Address - Phone:217-523-3636
Mailing Address - Fax:217-522-1404
Practice Address - Street 1:1511 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2806
Practice Address - Country:US
Practice Address - Phone:217-523-3636
Practice Address - Fax:217-544-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33605341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590128389OtherPALMETTO GBA RR MEDICARE
IL002186OtherHEALTH ALLIANCE
IL08490004OtherBLUE CROSS BLUE SHIELD
IL0075620OtherUNTD MINE WORKERS OF AM
IL31750OtherPRSNL CARE INS OF IL INC
IL002186OtherHEALTH ALLIANCE