Organization
VILLAGE OF PEORIA HEIGHTS
Active
Other names
PEORIA HEIGHTS AMBULANCE SERVICE
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES MAROTTA (AMBULANCE ADMINISTRATOR)
(309) 686-2386
Entity
Organization
Contact information
Practice address
4901 N PROSPECT RD, PEORIA HEIGHTS, IL 61616-5397
(309) 686-2370
(309) 682-3089
Mailing address
PO BOX 457, WHEELING, IL 60090-0457
(847) 577-8811
(847) 577-3518
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
22572
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07232092
BLUE CROSS BLUE SHIELD
ID
01
—
590006195
RAILROAD MEDICARE
IL
Enumeration date
03/01/2007
Last updated
04/23/2012
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