Organization
MEDSTAR AMBULANCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH D KELLEY (HUMANRESOURCES MANAGER)
(618) 443-5061
Entity
Organization
Contact information
Practice address
705 BRADBURY LN, SPARTA, IL 62286-2102
(618) 443-5061
(618) 443-3897
Mailing address
PO BOX 296, SPARTA, IL 62286-0296
(618) 443-5061
(618) 443-3897
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
44837
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007915009
BCBS
—
01
—
088141300
FEDERAL BLACK LUNG
—
01
—
133392100
AWCE/DEPT OF LABOR
—
01
—
154099XX
PREFERRED CARE
—
Enumeration date
08/23/2005
Last updated
05/08/2026
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