Tri District Emergency Ambulance

Primary specialty

ParamedicTaxonomy code 146L00000X

License

01103601 Issued in IL

Legal business name

TRI DISTRICT EMERGENCY AMBULANCE

Practice address

7563 Il Route 75
Rock City, IL 61070-0117

Phone

(815) 865-5153

Fax

(815) 865-5153

NPI assigned

May 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Edward L Koelling

Title

President / Supervisor

Phone

(815) 865-5153

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332892800000",
    "number": "1023219094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 117",
            "address_2": "7563 IL ROUTE 75",
            "city": "ROCK CITY",
            "state": "IL",
            "postal_code": "610700117",
            "telephone_number": "815-865-5153",
            "fax_number": "815-865-5153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7563 IL ROUTE 75",
            "city": "ROCK CITY",
            "state": "IL",
            "postal_code": "610700117",
            "telephone_number": "815-865-5153",
            "fax_number": "815-865-5153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI DISTRICT EMERGENCY AMBULANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2012-03-28",
        "status": "A",
        "authorized_official_last_name": "KOELLING",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT / SUPERVISOR",
        "authorized_official_telephone_number": "815-865-5153"
    },
    "taxonomies": [
        {
            "code": "146L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medical Technician, Paramedic",
            "state": "IL",
            "license": "01103601",
            "primary": true
        },
        {
            "code": "146M00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medical Technician, Intermediate",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Nelson, AT., ATC
• Kathleen A. Zachara, LPN,RCS

• Paramedic in Rock City, IL
• Providers in Rock City, IL by specialty
• Paramedic in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.