Provider Demographics
NPI:1144265711
Name:MARTINS AMBULANCE INC
Entity type:Organization
Organization Name:MARTINS AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRISIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-468-0200
Mailing Address - Street 1:386 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1604
Mailing Address - Country:US
Mailing Address - Phone:815-468-0200
Mailing Address - Fax:815-468-0600
Practice Address - Street 1:386 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1604
Practice Address - Country:US
Practice Address - Phone:815-468-0200
Practice Address - Fax:815-468-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========0001Medicaid
IL=========0001Medicaid