Provider Demographics
NPI:1841220688
Name:COUNTY OF WHITE
Entity Type:Organization
Organization Name:COUNTY OF WHITE
Other - Org Name:WHITE COUNTY AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-382-2604
Mailing Address - Street 1:314 E CHERRY ST
Mailing Address - Street 2:PO BOX 339
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-1862
Mailing Address - Country:US
Mailing Address - Phone:618-382-2604
Mailing Address - Fax:618-384-4084
Practice Address - Street 1:314 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1862
Practice Address - Country:US
Practice Address - Phone:618-382-2604
Practice Address - Fax:618-384-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL50043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9770572OtherBCBS
IL613693900OtherDEPT OF LABOR OWCP
IL=========OtherTRICARE NORTH
IL9770572OtherBCBS
IL=========OtherTRICARE NORTH
IL647960Medicare PIN