Organization
COUNTY OF JASPER
Active
Other names
Jasper County Ambulance Service
Organization subpart
No
Provider details
NPI number
Authorized official
LORI GUERRETTAZ (MANAGER)
(618) 783-8651
Entity
Organization
Contact information
Practice address
204 W JOURDAN ST, NEWTON, IL 62448-1931
(618) 783-8651
(618) 783-5812
Mailing address
204 W JOURDAN ST, NEWTON, IL 62448-1931
(618) 783-8651
(618) 783-5812
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
—
—
3416L0300X
Land Ambulance
Primary
65147
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
233110
PTAN
IL
01
—
65147
IDPH LICENSE
IL
Enumeration date
08/24/2006
Last updated
12/05/2024
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