Sandoval Volunteer Fire Dept

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

5156 Issued in IL

Legal business name

SANDOVAL VOLUNTEER FIRE DEPT

Practice address

109 N Wall St
Sandoval, IL 62882

Phone

(618) 247-3870

Fax

(618) 247-3251

NPI assigned

Jul 5, 2006

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James Gore

Title

Fire Chief

Phone

(618) 247-3870

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sandoval Fire Protection District Other name

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": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1194756874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 457",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600900457",
            "telephone_number": "847-577-8811",
            "fax_number": "847-577-7967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N WALL ST",
            "city": "SANDOVAL",
            "state": "IL",
            "postal_code": "62882",
            "telephone_number": "618-247-3870",
            "fax_number": "618-247-3251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDOVAL VOLUNTEER FIRE DEPT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "618-247-3870"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "5156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "6132033",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sandoval Fire Protection District",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kelly Ruth Hall, NP-C
• William J Henson, LCSW
• Sandoval CC SCH Dist 501
• Rama M Seats
• Serenitypass Holistic Health PLLC
• Kenzi Wood

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.