FORMAN AMBULANCE SERVICE; NPI #1700871910

Contact Information

FORMAN AMBULANCE SERVICE

205 N BROADWAY
MANITO, IL 61546-0648

Phone: 309-968-6902
Fax: 309-968-6649
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Air Transport	3416A0800X	59	Ambulance Service Provider

Indicates primary specialty

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NPI Profile & details for FORMAN AMBULANCE SERVICE

NPI Number 1700871910

LBN Legal business name FORMAN AMBULANCE SERVICE

Authorized official SHERON BORTELL - (AUTHORIZED OFFICIAL)

Entity Organization

Organization subpart ¹ No

Enumeration date 09/14/2005

Last updated 05/11/2023 - About 3 years ago

Identifiers

IL	License #	1660298
IL	Medicaid	237154244001

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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FORMAN AMBULANCE SERVICE

Contact Information

Specialty

Air Transport

NPI Profile & details for FORMAN AMBULANCE SERVICE

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