Provider Demographics
NPI:1891240842
Name:WHITE COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:WHITE COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-382-2604
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-0339
Mailing Address - Country:US
Mailing Address - Phone:618-382-2406
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:62821-1853
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:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILEMS216070341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance