Provider Demographics
NPI:1528075850
Name:HANOVER AMBULANCE, INC
Entity type:Organization
Organization Name:HANOVER AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF EMT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-591-3767
Mailing Address - Street 1:3920 13TH AVE E
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3675
Mailing Address - Country:US
Mailing Address - Phone:218-263-7540
Mailing Address - Fax:
Practice Address - Street 1:10 FOX STREET
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:IL
Practice Address - Zip Code:61041
Practice Address - Country:US
Practice Address - Phone:815-591-3767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004370616OtherBCBS
IL=========001Medicaid
IL=========001Medicaid
IL590003413Medicare PIN