# MILLSTADT AMBULANCE SERVICE

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

## Provider details

- **NPI number:** 1780709139
- **Authorized official:** JENNIFER MARIE GOETZ (CHIEF)
- **Authorized official phone:** (618) 476-1201

## Contact information

- **Practice address:** 100 E LAUREL ST, MILLSTADT, IL 62260-1510
- **Practice address phone:** (618) 476-1201
- **Mailing address:** PO BOX 547, WHEELING, IL 60090-0547
- **Mailing address phone:** (618) 476-1201
- **Mailing address fax:** (336) 791-0196

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 34 | IL | Yes |

## Other

- **Enumeration date:** 03/21/2007
- **Last updated:** 02/07/2026