Provider Demographics
NPI:1528157203
Name:RAYMOND HARVEL AREA AMBULANCE SERVICE
Entity type:Organization
Organization Name:RAYMOND HARVEL AREA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAURICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-532-9561
Mailing Address - Street 1:120 N MAIN
Mailing Address - Street 2:PO BOX 523
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049
Mailing Address - Country:US
Mailing Address - Phone:217-532-9561
Mailing Address - Fax:217-532-9608
Practice Address - Street 1:125 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:IL
Practice Address - Zip Code:62560
Practice Address - Country:US
Practice Address - Phone:217-229-3522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL775460Medicare ID - Type Unspecified