Provider Demographics
NPI:1205943594
Name:PLATINUM CARE AMBULANCE INC
Entity type:Organization
Organization Name:PLATINUM CARE AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-778-8585
Mailing Address - Street 1:1692 QUINCY AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5012
Mailing Address - Country:US
Mailing Address - Phone:630-778-8585
Mailing Address - Fax:
Practice Address - Street 1:1665 QUINCY AVE STE 115
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-3994
Practice Address - Country:US
Practice Address - Phone:630-778-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL88057341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL208567Medicare ID - Type UnspecifiedMEDICARE NUMBER