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Organization
FORMAN AMBULANCE SERVICE
Active
Organization
FORMAN AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERON KAYE BORTELL (AUTHORIZED OFFICIAL)
(309) 968-6902
Entity
Organization
Contact information
Practice address
205 N BROADWAY, MANITO, IL 61546-0648
(309) 968-6902
(309) 968-6649
Mailing address
PO BOX 648, MANITO, IL 61546-0648
(309) 968-6902
(309) 968-6649
Taxonomy
Speciality
Code
Description
License number
State
3416A0800X
Air Ambulance
Primary
1660298
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
237154244001
—
IL
Enumeration date
09/14/2005
Last updated
05/11/2023
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