Jon Richmond Gieseking
Individual provider Active NPI Ambulance · Altamont, IL
NPI 1114196375 · NPPES record last updated Sep 14, 2010
Key facts
- NPI
- 1114196375
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Ambulance 341600000X
- License
- 510601 (IL)
- Practice address
- 208 N 2ND St
Altamont, IL 62411-1402 - Phone
- (618) 483-6821
- NPI assigned
- Feb 21, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 510601 | IL | MD | Ambulance |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 510601 | IL | Yes |
Addresses
Primary practice location
208 N 2ND St
Altamont, IL 62411-1402
Mailing address
PO Box 457
Wheeling, IL 60090-0457
Phone (847) 577-8811
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 371199058002 | Medicaid | IL |
Other providers in Altamont, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.