Provider Demographics
NPI:1336233196
Name:GALLATIN COUNTY AMBULANCE LLC
Entity Type:Organization
Organization Name:GALLATIN COUNTY AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-997-4915
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 1:204 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:IL
Practice Address - Zip Code:62979
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:2006-10-03
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL52103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10032082OtherBLUE CROSS BLUE SHIELD
8100188OtherUNITED HEALTHCARE
195037OtherHEALTHLINK, INC
073719OtherHEALTH ALLIANCE
IL=========001Medicaid
IL548720Medicare PIN