# NEW BOSTON VOLUNTEER AMBULANCE SERVICE, INC

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

## Provider details

- **NPI number:** 1881728459
- **Authorized official:** DONALD E BACON (SECRETARY/TREASURER)
- **Authorized official phone:** (309) 587-8213

## Contact information

- **Practice address:** 602 BROADWAY, NEW BOSTON, IL 61272-0066
- **Practice address phone:** (309) 587-8213
- **Practice address fax:** (309) 587-2029
- **Mailing address:** 209 WASHINGTON, NEW BOSTON, IL 61272-0066
- **Mailing address phone:** (309) 587-8213

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 22540 | IL | Yes |
| 3416L0300X | Land Ambulance | 22540 | NULL | — |

## Other

- **Enumeration date:** 03/15/2007
- **Last updated:** 12/29/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 06632003 | BLUE CROSS BLUE SHIELD | IL |
| 05 | — | 590003560 | — | IL |