Organization
NORTHERN EDGAR COUNTY AMB SER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA M FLETCHER (SECRETARY TRESURER)
(217) 269-3022
Entity
Organization
Contact information
Practice address
110 S IOWA, CHRISMAN, IL 61924-0144
(217) 269-3022
(217) 269-2348
Mailing address
110 S IOWA, PO BOX 144, CHRISMAN, IL 61924-0144
(217) 269-3022
(217) 269-2348
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
653301
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2332001
BLUE CROSS BLUE SHIELD
IL
Enumeration date
02/22/2007
Last updated
08/22/2020
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