Provider Demographics
NPI:1801580543
Name:CODE BLUE EMS LLC
Entity type:Organization
Organization Name:CODE BLUE EMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:217-663-3783
Mailing Address - Street 1:207 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TEUTOPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62467-1023
Mailing Address - Country:US
Mailing Address - Phone:217-663-3783
Mailing Address - Fax:
Practice Address - Street 1:207 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-1023
Practice Address - Country:US
Practice Address - Phone:217-663-3783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport