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Organization
SOUTH EAST LIVINGSTON COUNTY AMBULANCE SERVICE, INC
Active
Organization
SOUTH EAST LIVINGSTON COUNTY AMBULANCE SERVICE, INC
Active
Other names
SELCAS Ambulance
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY STOLLER (PROCUREMENT OFFICER)
(815) 692-3658
Entity
Organization
Contact information
Practice address
310 W LOCUST ST, FAIRBURY, IL 61739-1068
(815) 692-3452
(815) 692-2414
Mailing address
310 W LOCUST ST, FAIRBURY, IL 61739-1068
(815) 692-3452
(815) 692-2414
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
26721
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5390005
BCBS OF IL PROVIDER #
IL
01
—
590011250
RAILROAD MEDICARE
IL
Enumeration date
07/27/2005
Last updated
02/11/2026
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