Provider Demographics
NPI:1538254776
Name:BISMARCK COMMUNITY AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:BISMARCK COMMUNITY AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-649-5097
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:IL
Mailing Address - Zip Code:61814-0065
Mailing Address - Country:US
Mailing Address - Phone:217-759-3164
Mailing Address - Fax:
Practice Address - Street 1:16903 E 2750 N RD
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:IL
Practice Address - Zip Code:61814
Practice Address - Country:US
Practice Address - Phone:217-759-3164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL006693341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
611124900OtherBLACK LUNG
9232001OtherBLUE CROSS
IL=========01Medicaid
IL=========01Medicaid