Organization
EMERGENCY 116 AMBULANCE SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD P KOURI (TREASURER)
(309) 367-2786
Entity
Organization
Contact information
Practice address
120 S DAVENPORT ST, METAMORA, IL 61548
(309) 367-2640
Mailing address
PO BOX 36, METAMORA, IL 61548-0036
(309) 367-2786
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10270649
BCBS
IL
01
—
590000219
RAILROAD MEDICARE
IL
Enumeration date
07/25/2006
Last updated
11/29/2011
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