Basic Information
| Provider Information | |||||||||
| NPI: | 1295801751 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUTTON AMBULANCE SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 457 | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600900457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475778811 | ||||||||
| FaxNumber: | 8475773518 | ||||||||
| Practice Location | |||||||||
| Address1: | 327 N CLAY ST | ||||||||
| Address2: | |||||||||
| City: | TAYLORVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625681801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178242275 | ||||||||
| FaxNumber: | 2178242451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SUTTON | ||||||||
| AuthorizedOfficialFirstName: | BETTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2178242275 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 3011 | IL | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 1170419 | 01 | IL | BCBS | OTHER |