Provider Demographics
NPI:1619245339
Name:MYERS, TOBY (PARAMEDIC)
Entity Type:Individual
Prefix:MR
First Name:TOBY
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 ILLINOIS ROUTE 164
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401
Mailing Address - Country:US
Mailing Address - Phone:309-342-3134
Mailing Address - Fax:309-342-0744
Practice Address - Street 1:58 ILLINOIS ROUTE 164
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-8506
Practice Address - Country:US
Practice Address - Phone:309-342-3134
Practice Address - Fax:309-342-0744
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILP000547547146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic