Provider Demographics
NPI:1386758126
Name:EDGAR COUNTY SPECIAL SERVICE AREA AMBULANCE, INC.
Entity type:Organization
Organization Name:EDGAR COUNTY SPECIAL SERVICE AREA AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-463-5200
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-0937
Mailing Address - Country:US
Mailing Address - Phone:217-463-5200
Mailing Address - Fax:217-463-5112
Practice Address - Street 1:1703 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2944
Practice Address - Country:US
Practice Address - Phone:217-463-5200
Practice Address - Fax:217-463-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL66706341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00079793OtherRAILROAD MEDICARE
IL2327921OtherBLUE CROSS BLUE SHIELD
ILP00079793OtherRAILROAD MEDICARE
IL=========001Medicaid