Provider Demographics
NPI:1144354432
Name:NORTH HENDERSON COUNTY AMBULANCE SERVICE INC.
Entity type:Organization
Organization Name:NORTH HENDERSON COUNTY AMBULANCE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:JERN
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:319-752-4032
Mailing Address - Street 1:PO BOX 866
Mailing Address - Street 2:
Mailing Address - City:OQUAWKA
Mailing Address - State:IL
Mailing Address - Zip Code:61469-0866
Mailing Address - Country:US
Mailing Address - Phone:309-867-2452
Mailing Address - Fax:
Practice Address - Street 1:411 WARREN ST
Practice Address - Street 2:
Practice Address - City:OQUAWKA
Practice Address - State:IL
Practice Address - Zip Code:61469
Practice Address - Country:US
Practice Address - Phone:309-867-2452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17707783416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL203837Medicare ID - Type Unspecified