Provider Demographics
NPI:1790707701
Name:EMERGENCY 116 AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:EMERGENCY 116 AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-367-2786
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-0036
Mailing Address - Country:US
Mailing Address - Phone:309-367-2786
Mailing Address - Fax:
Practice Address - Street 1:120 S DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548
Practice Address - Country:US
Practice Address - Phone:309-367-2640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590000219OtherRAILROAD MEDICARE
IL10270649OtherBCBS
IL=========001Medicaid
IL590000219OtherRAILROAD MEDICARE