# NORTHERN EDGAR COUNTY AMB SER

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003941139
- **Authorized official:** LAURA M FLETCHER (SECRETARY TRESURER)
- **Authorized official phone:** (217) 269-3022

## Contact information

- **Practice address:** 110 S IOWA, CHRISMAN, IL 61924-0144
- **Practice address phone:** (217) 269-3022
- **Practice address fax:** (217) 269-2348
- **Mailing address:** 110 S IOWA, PO BOX 144, CHRISMAN, IL 61924-0144
- **Mailing address phone:** (217) 269-3022
- **Mailing address fax:** (217) 269-2348

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 653301 | IL | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2332001 | BLUE CROSS BLUE SHIELD | IL |