National Provider Identifier Database

FORMAN AMBULANCE SERVICE
Air Transport


Contact Information

FORMAN AMBULANCE SERVICE
205 N BROADWAY
MANITO, IL61546-0648
Phone: 309-968-6902
Fax: 309-968-6649
Website:
Specialty Taxonomy Code
* Air Transport 3416A0800X

* Indicates primary specialty

NPI Profile & details for FORMAN AMBULANCE SERVICE

NPI Number 1700871910
Legal business name
LBN
FORMAN AMBULANCE SERVICE
Authorized official SHERON BORTELL - (AUTHORIZED OFFICIAL)
Entity Organization
Organization subpart No
Enumeration date 09/14/2005
Last updated 05/11/2023 - About 3 years ago
Sole proprietor1 Not specified
Identifiers
  • IL License #: 1660298
  • IL Medicaid: 237154244001

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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