Provider Demographics
NPI:1720227069
Name:POLO COMMUNITY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:POLO COMMUNITY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-946-2153
Mailing Address - Street 1:206 S FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:POLO
Mailing Address - State:IL
Mailing Address - Zip Code:61064-1716
Mailing Address - Country:US
Mailing Address - Phone:815-946-2153
Mailing Address - Fax:815-946-4266
Practice Address - Street 1:206 S FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:POLO
Practice Address - State:IL
Practice Address - Zip Code:61064-1716
Practice Address - Country:US
Practice Address - Phone:815-946-2153
Practice Address - Fax:815-946-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance