Organization
A-ADVANTAGE AMBULANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM DIETZ (DIRECTOR OF PATIENT ACCOUNTS)
(708) 995-1187
Entity
Organization
Contact information
Practice address
9850 W 190TH ST, SUITE B-10, MOKENA, IL 60448-5604
(708) 995-1187
(708) 995-7230
Mailing address
9850 W 190TH ST STE B-10, MOKENA, IL 60448-5604
(708) 995-1187
(708) 995-7230
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
8061
IL
343800000X
Secured Medical Transport (VAN)
8061
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201379657001
—
IL
Enumeration date
10/12/2015
Last updated
10/12/2015
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