Provider Demographics
NPI:1902927379
Name:FLANAGAN-GRAYMONT EMERGENCY AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:FLANAGAN-GRAYMONT EMERGENCY AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-796-4249
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:FLANAGAN
Mailing Address - State:IL
Mailing Address - Zip Code:61740-0363
Mailing Address - Country:US
Mailing Address - Phone:815-796-4249
Mailing Address - Fax:815-796-4249
Practice Address - Street 1:101 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FLANAGAN
Practice Address - State:IL
Practice Address - Zip Code:61740-7550
Practice Address - Country:US
Practice Address - Phone:815-796-2689
Practice Address - Fax:815-796-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL265083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590001338OtherRAILROAD MEDICARE
IL590001338OtherRAILROAD MEDICARE
IL590001338OtherRAILROAD MEDICARE