# GERALD M DUFFY TRUST UW

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Duffy Ambulance Service
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932220829
- **Authorized official:** MRS. KRISTIN M PITTE (TRUSTEE)
- **Authorized official phone:** (815) 844-7111

## Contact information

- **Practice address:** 122 E HOWARD ST, PONTIAC, IL 61764-1918
- **Practice address phone:** (815) 844-7111
- **Practice address fax:** (815) 842-1061
- **Mailing address:** 202 E HOWARD ST, PONTIAC, IL 61764-1920
- **Mailing address phone:** (815) 844-7111
- **Mailing address fax:** (815) 842-1061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 26718 | IL | Yes |

## Other

- **Enumeration date:** 04/02/2007
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001803 | HEALTH ALLIANCE | IL |
| 01 | — | 5390001 | BLUE CROSS BLUE SHIELD | IL |
| 01 | — | P00221706 | RAILROAD MEDICARE | IL |