Provider Demographics
NPI:1871796391
Name:BUNKER HILL AREA AMBULANCE SVC.
Entity type:Organization
Organization Name:BUNKER HILL AREA AMBULANCE SVC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DYANE
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:618-585-3329
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62014-0309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:618-585-1297
Practice Address - Street 1:123 SOUTH WASHINGTON
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:IL
Practice Address - Zip Code:62014-0309
Practice Address - Country:US
Practice Address - Phone:618-585-3329
Practice Address - Fax:618-585-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33617341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL927300Medicare ID - Type UnspecifiedTRANSPORTATION