Organization
NEW BOSTON VOLUNTEER AMBULANCE SERVICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD E BACON (SECRETARY/TREASURER)
(309) 587-8213
Entity
Organization
Contact information
Practice address
602 BROADWAY, NEW BOSTON, IL 61272-0066
(309) 587-8213
(309) 587-2029
Mailing address
209 WASHINGTON, NEW BOSTON, IL 61272-0066
(309) 587-8213
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
22540
IL
3416L0300X
Land Ambulance
22540
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06632003
BLUE CROSS BLUE SHIELD
IL
05
—
590003560
—
IL
Enumeration date
03/15/2007
Last updated
12/29/2011
Update your record
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