# COUNTY OF PULASKI

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

## Provider details

- **NPI number:** 1043319148
- **Authorized official:** TRACIE DAWN HAFFORD (DIRECTOR)
- **Authorized official phone:** (314) 677-0185

## Contact information

- **Practice address:** 75 CAMO CLAD DR, PULASKI COUNTY AMBULANCE, MOUNDS, IL 62964
- **Practice address phone:** (618) 342-6209
- **Practice address fax:** (618) 342-6254
- **Mailing address:** PO BOX 52, MOUNDS, IL 62964-0052
- **Mailing address phone:** (618) 342-6209
- **Mailing address fax:** (618) 342-6254

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | — | NULL | — |
| 3416L0300X | Land Ambulance | — | NULL | Yes |

## Other

- **Enumeration date:** 09/22/2006
- **Last updated:** 08/11/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 07770390 | BLUE CROSS BLUE SHIELD | IL |
| 05 | — | 371076724001 | — | IL |
| 01 | — | 590000202 | RAIL ROAD MEDICARE | IL |