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Organization

PRAIRIELAND COMMUNITY AMBULANCE SERVICE CO

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN EARLEY (BOARD PRESIDENT)
(217) 899-3135
Entity
Organization

Contact information

Practice address
610 S SPRINGFIELD ST, VIRDEN, IL 62690-0023
(217) 965-5999
(217) 965-5714
Mailing address
PO BOX 23, VIRDEN, IL 62690-0023
(217) 965-5999
(217) 965-5714

Taxonomy

Speciality
Code
Description
License number
State
341600000X
Ambulance
33643
IL
3416L0300X
Land Ambulance
Primary
3643
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0005932045
BLUE CROSS BLUE SHIELD
IL
01
613448800
DOL/OWEP
IL
Enumeration date
03/14/2007
Last updated
10/25/2023
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