Provider Demographics
NPI:1770617748
Name:PRAIRIELAND COMMUNITY AMBULANCE SERVICE CO
Entity type:Organization
Organization Name:PRAIRIELAND COMMUNITY AMBULANCE SERVICE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-899-3135
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:VIRDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62690-0023
Mailing Address - Country:US
Mailing Address - Phone:217-965-5999
Mailing Address - Fax:217-965-5714
Practice Address - Street 1:610 S SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:VIRDEN
Practice Address - State:IL
Practice Address - Zip Code:62690-0023
Practice Address - Country:US
Practice Address - Phone:217-965-5999
Practice Address - Fax:217-965-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33643341600000X
IL36433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005932045OtherBLUE CROSS BLUE SHIELD
IL613448800OtherDOL/OWEP
IL613448800OtherDOL/OWEP
IL576830Medicare UPIN