Provider Demographics
NPI:1851412357
Name:CITY OF BEARDSTOWN
Entity Type:Organization
Organization Name:CITY OF BEARDSTOWN
Other - Org Name:CITY OF BEARDSTOWN AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:V
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-323-3110
Mailing Address - Street 1:105 W 3RD ST
Mailing Address - Street 2:P.O. BOX 467
Mailing Address - City:BEARDSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62618-1142
Mailing Address - Country:US
Mailing Address - Phone:217-323-3110
Mailing Address - Fax:217-323-4029
Practice Address - Street 1:1119 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:BEARDSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62618-1925
Practice Address - Country:US
Practice Address - Phone:217-323-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL34523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590007380OtherMEDICARE RAILROAD
IL590007380OtherMEDICARE RAILROAD
IL=========OtherFEDERAL TAX ID NUMBER
IL590007380OtherMEDICARE RAILROAD