Provider Demographics
NPI:1962547315
Name:COULTERVILLE EMERGENCY AMBULANCE SERVICE
Entity type:Organization
Organization Name:COULTERVILLE EMERGENCY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERKTREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-758-2813
Mailing Address - Street 1:114 N. FOURTH STREET
Mailing Address - Street 2:P.O. BOX 374
Mailing Address - City:COULTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62237-0374
Mailing Address - Country:US
Mailing Address - Phone:618-758-2813
Mailing Address - Fax:
Practice Address - Street 1:114 N. FOURTH STREET
Practice Address - Street 2:
Practice Address - City:COULTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62237-0374
Practice Address - Country:US
Practice Address - Phone:618-758-2813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4 4834341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227960Medicare NSC