Provider Demographics
NPI:1043976061
Name:NOKOMIS-WITT AREA AMBULANCE SERVICE
Entity type:Organization
Organization Name:NOKOMIS-WITT AREA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCQ
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:217-710-4485
Mailing Address - Street 1:10 BRANDON LN
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:IL
Mailing Address - Zip Code:62075-9232
Mailing Address - Country:US
Mailing Address - Phone:217-710-4485
Mailing Address - Fax:217-563-7615
Practice Address - Street 1:10 BRANDON LN
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:IL
Practice Address - Zip Code:62075-9232
Practice Address - Country:US
Practice Address - Phone:217-710-4485
Practice Address - Fax:217-563-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-14
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance