# TRI-COUNTY AMBULANCE DISTRICT

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

## Provider details

- **NPI number:** 1508891367
- **Authorized official:** SCOTT ROGER LAKE (DIRECTOR)
- **Authorized official phone:** (309) 337-4272

## Contact information

- **Practice address:** 2495 SHEPHERD DR, RIO, IL 61472-9802
- **Practice address phone:** (309) 337-4272
- **Mailing address:** PO BOX 97, WOODHULL, IL 61490-0097
- **Mailing address phone:** (309) 337-4272

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 2606 | IL | Yes |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 04/26/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 370999628001 | — | IL |