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Organization

MVK AMBULANCE SERVICE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TAMARA HALTERMAN (COORDINATOR)
(815) 448-2134
Entity
Organization

Contact information

Practice address
604 FRONT ST, MAZON, IL 60444
(815) 448-2134
Mailing address
PO BOX 316, MAZON, IL 60444-0316
(815) 448-2134

Taxonomy

Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
792201
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3221361
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/17/2006
Last updated
04/20/2011
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