Provider Demographics
NPI:1013960715
Name:PINCKNEYVILLE AMBULANCE SERVICE
Entity Type:Organization
Organization Name:PINCKNEYVILLE AMBULANCE SERVICE
Other - Org Name:PINCKNEYVILLE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:G
Authorized Official - Last Name:LIPE
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:618-357-2222
Mailing Address - Street 1:508 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-1740
Mailing Address - Country:US
Mailing Address - Phone:618-357-2222
Mailing Address - Fax:618-357-6512
Practice Address - Street 1:508 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1740
Practice Address - Country:US
Practice Address - Phone:618-357-2222
Practice Address - Fax:618-357-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL551583416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07370132OtherBLUE CROSS BLUE SHIELD
ILN269676Medicaid
IL898518OtherBLACK LUNG PROGRAM
OH2633994Medicaid
IL07370132OtherBLUE CROSS BLUE SHIELD
ILN269676Medicaid
IL777370Medicare ID - Type Unspecified