Provider Demographics
NPI:1013050897
Name:CERRO GORDO COMM AMB SRVC
Entity Type:Organization
Organization Name:CERRO GORDO COMM AMB SRVC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTORS PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CURT
Authorized Official - Middle Name:
Authorized Official - Last Name:VULGAMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-763-5251
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:304 E NORTH ST
Mailing Address - City:CERRO GORDO
Mailing Address - State:IL
Mailing Address - Zip Code:61818-0181
Mailing Address - Country:US
Mailing Address - Phone:217-763-5251
Mailing Address - Fax:217-763-6173
Practice Address - Street 1:304 E NORTH ST
Practice Address - Street 2:
Practice Address - City:CERRO GORDO
Practice Address - State:IL
Practice Address - Zip Code:61818-0181
Practice Address - Country:US
Practice Address - Phone:217-763-5251
Practice Address - Fax:217-763-6173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL665413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL697410Medicare ID - Type Unspecified