# GULFPORT AMBULANCE SERVICE

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

## Provider details

- **NPI number:** 1467664938
- **Authorized official:** MR. ED RONNER (DIRECTOR)
- **Authorized official phone:** (309) 873-2575

## Contact information

- **Practice address:** RR 1 BOX 84, CARMAN, IL 61425-9718
- **Practice address phone:** (309) 873-2575
- **Mailing address:** RR 1 BOX 84, CARMAN, IL 61425-9718

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 1770779 | IL | Yes |

## Other

- **Enumeration date:** 05/04/2007
- **Last updated:** 08/12/2008