Organization
SOUTH EAST LIVINGSTON COUNTY AMBULANCE SERVICE, INC
Active
Other names
SELCAS Ambulance
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY STOLLER (PROCUREMENT OFFICER)
(815) 692-3658
Entity
Organization
Contact information
Practice address
310 W LOCUST ST, FAIRBURY, IL 61739-1068
(815) 692-3452
(815) 692-2414
Mailing address
310 W LOCUST ST, FAIRBURY, IL 61739-1068
(815) 692-3452
(815) 692-2414
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
26721
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5390005
BCBS OF IL PROVIDER #
IL
01
—
590011250
RAILROAD MEDICARE
IL
Enumeration date
07/27/2005
Last updated
02/11/2026
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