Provider Demographics
NPI:1447621875
Name:A-ADVANTAGE AMBULANCE LLC
Entity type:Organization
Organization Name:A-ADVANTAGE AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-995-1187
Mailing Address - Street 1:9850 W 190TH ST STE B-10
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-5604
Mailing Address - Country:US
Mailing Address - Phone:708-995-1187
Mailing Address - Fax:708-995-7230
Practice Address - Street 1:9850 W 190TH ST
Practice Address - Street 2:SUITE B-10
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-5604
Practice Address - Country:US
Practice Address - Phone:708-995-1187
Practice Address - Fax:708-995-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL80613416L0300X, 343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201379657001Medicaid
IL2100073Medicare Oscar/Certification