Provider Demographics
NPI:1386699759
Name:ADVANTAGE AMBULANCE, INC
Entity type:Organization
Organization Name:ADVANTAGE AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-478-0455
Mailing Address - Street 1:22809 S MUSTANG RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2506
Mailing Address - Country:US
Mailing Address - Phone:708-478-0455
Mailing Address - Fax:708-478-1628
Practice Address - Street 1:1020 E STATE PKWY
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4577
Practice Address - Country:US
Practice Address - Phone:847-413-1133
Practice Address - Fax:847-885-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL80613416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid