Provider Demographics
NPI:1841823168
Name:ILLIANA EMS, INC.
Entity type:Organization
Organization Name:ILLIANA EMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAUGHNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-820-5050
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-0056
Mailing Address - Country:US
Mailing Address - Phone:765-820-5050
Mailing Address - Fax:765-820-1108
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-2420
Practice Address - Country:US
Practice Address - Phone:765-820-5050
Practice Address - Fax:765-820-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300047213Medicaid
IN300018375Medicaid