Provider Demographics
NPI:1629169255
Name:COUNTY OF PIKE
Entity Type:Organization
Organization Name:COUNTY OF PIKE
Other - Org Name:PIKE COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIKE COUNTY AMBULANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-285-9033
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-0366
Mailing Address - Country:US
Mailing Address - Phone:217-285-6336
Mailing Address - Fax:217-285-9053
Practice Address - Street 1:624 W. WASHINGTON
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-0366
Practice Address - Country:US
Practice Address - Phone:217-285-9033
Practice Address - Fax:217-285-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590128846OtherRAILROAD MEDICARE
IL010732OtherHEALTH ALLIANCE
MO187342OtherBLUE CROSS BLUE SHIELD
IL0007532004OtherBLUE CROSS BLUE SHIELD
IL131049OtherHEALTHLINK
MO187342OtherBLUE CROSS BLUE SHIELD
IL131049OtherHEALTHLINK