Decatur Ambulance Service, Inc.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

66510 Issued in IL

Legal business name

DECATUR AMBULANCE SERVICE, INC.

Practice address

417 W Wood St
Decatur, IL 62522-3109

Phone

(217) 428-8641

Fax

(217) 362-5898

NPI assigned

Oct 27, 2005

Organization subpart

No

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

Authorized official

Name

Mr. David A Krause

Title

VP-Administration

Phone

(217) 362-5931

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174513485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 W WOOD ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625223109",
            "telephone_number": "217-428-8641",
            "fax_number": "217-362-5898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 W WOOD ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625223109",
            "telephone_number": "217-428-8641",
            "fax_number": "217-362-5898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR AMBULANCE SERVICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KRAUSE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP-ADMINISTRATION",
        "authorized_official_telephone_number": "217-362-5931",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "66510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "5890002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Decatur 2012 LLC
• Decatur 2013 LLC
• Decatur 2014
• Decatur 2015 LLC
• Decatur 2016 LLC
• Decatur Athletic Club
• Decatur City Taxi & Delivery Inc
• Decatur Counseling Center, LLC
• Decatur Digestive Disease Center LLC
• Decatur Digestive Disease Center LLC

• Land Ambulance in Decatur, IL
• Providers in Decatur, IL by specialty
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.