Provider Demographics
NPI:1710217377
Name:MIDWEST AMBULANCE, LLC
Entity Type:Organization
Organization Name:MIDWEST AMBULANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-745-0050
Mailing Address - Street 1:8111 SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2968
Mailing Address - Country:US
Mailing Address - Phone:847-745-0050
Mailing Address - Fax:847-745-0051
Practice Address - Street 1:8111 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2968
Practice Address - Country:US
Practice Address - Phone:847-745-0050
Practice Address - Fax:847-745-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL10 72683416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport