Provider Demographics
NPI:1285762393
Name:ROSSVILLE COMMUNITY AMBULANCE SERVICE
Entity type:Organization
Organization Name:ROSSVILLE COMMUNITY AMBULANCE SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-748-6061
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:P.O. BOX 176
Mailing Address - City:ROSSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60963-0176
Mailing Address - Country:US
Mailing Address - Phone:217-748-6061
Mailing Address - Fax:217-748-6061
Practice Address - Street 1:107 W ATTICA ST
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60963-1151
Practice Address - Country:US
Practice Address - Phone:217-748-6061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL37113465001Medicaid
IL740150Medicare PIN
IL37113465001Medicaid