Provider Demographics
NPI:1912020934
Name:MARION COUNTY AMBULANCE SERVICE INC.
Entity Type:Organization
Organization Name:MARION COUNTY AMBULANCE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ISAIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-775-8148
Mailing Address - Street 1:110 S. WOOD ST.
Mailing Address - Street 2:P.O. BOX 207
Mailing Address - City:ODIN
Mailing Address - State:IL
Mailing Address - Zip Code:62870-1185
Mailing Address - Country:US
Mailing Address - Phone:618-775-8148
Mailing Address - Fax:618-775-8149
Practice Address - Street 1:110 S. WOOD ST.
Practice Address - Street 2:207
Practice Address - City:ODIN
Practice Address - State:IL
Practice Address - Zip Code:62870-1185
Practice Address - Country:US
Practice Address - Phone:618-775-8148
Practice Address - Fax:618-775-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL389180OtherHEALTHLINK
IL0006122191OtherBLUE SHEILD
IL0006122191OtherBLUE SHEILD
IL=========001Medicaid
IL389180OtherHEALTHLINK