Provider Demographics
NPI:1255428140
Name:WILLIAMSON COUNTY AMBULANCE SERVICE, INC
Entity type:Organization
Organization Name:WILLIAMSON COUNTY AMBULANCE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-922-8670
Mailing Address - Street 1:808 E DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-3333
Mailing Address - Country:US
Mailing Address - Phone:618-997-4915
Mailing Address - Fax:618-993-3386
Practice Address - Street 1:808 E DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-3333
Practice Address - Country:US
Practice Address - Phone:618-997-4915
Practice Address - Fax:618-993-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
IL52103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
027487OtherHEALTH ALLIANCE
113139OtherHEALTHLINK, INC
087931100OtherDOL BLACK LUNG
IL10070554OtherBLUE CROSS BLUE SHIELD
590155539OtherRAILROAD MEDICARE
8181435OtherUNITED HEALTHCARE
IL=========001Medicaid
113139OtherHEALTHLINK, INC
8181435OtherUNITED HEALTHCARE