Organization
GALESBURG HOSPITALS' AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL E WIGNALL (ACCOUNTANT)
(309) 342-5144
Entity
Organization
Contact information
Practice address
2175 WINDISH DR, GALESBURG, IL 61401-9776
(309) 342-5144
(309) 342-4834
Mailing address
2175 WINDISH DR, GALESBURG, IL 61401-9776
(309) 342-5144
(309) 342-4834
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
022603
IL
3416L0300X
Land Ambulance
2603
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004870049
BLUE CROSS BLUE SHIELD
IL
01
—
14D0889590
CLIA
IL
Enumeration date
08/23/2005
Last updated
05/10/2012
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