Organization
AKRON PRINCEVILLE AMBULANCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFRED GARDNER (BOARD PRESIDENT)
(309) 682-5280
Entity
Organization
Contact information
Practice address
319 E MAIN STREET, PRINCEVILLE, IL 61559-0021
(309) 682-5280
(309) 682-5327
Mailing address
PO BOX 21, 319 E MAIN STREET, PRINCEVILLE, IL 61559-0021
(309) 682-5280
(309) 682-5327
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
000002611
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07232089
BLUE CROSS BLUE SHIELD
IL
01
—
590004694
PALMETTO GBA
—
Enumeration date
12/27/2007
Last updated
03/29/2012
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