Provider Demographics
NPI:1861474405
Name:SUGAR CREEK AMBULANCE SERVICE
Entity Type:Organization
Organization Name:SUGAR CREEK AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIEPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-224-9121
Mailing Address - Street 1:119 W INDIANA ST
Mailing Address - Street 2:P.O. BOX 1022
Mailing Address - City:TRENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62293-1318
Mailing Address - Country:US
Mailing Address - Phone:618-224-9121
Mailing Address - Fax:618-224-7296
Practice Address - Street 1:119 W INDIANA ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:IL
Practice Address - Zip Code:62293-1318
Practice Address - Country:US
Practice Address - Phone:618-224-9121
Practice Address - Fax:618-224-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4 40143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport