Village of Crete

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

7314 Issued in IL

Legal business name

VILLAGE OF CRETE

Practice address

524 W Exchange St
Crete, IL 60417-2139

Phone

(708) 672-5431

Fax

(708) 672-3920

NPI assigned

Jul 15, 2006

Organization subpart

No

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

Authorized official

Name

Michael Waterman

Title

Fire Chief

Phone

(708) 672-5431

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Crete Fire Department Other name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1205852639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1053",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604482052",
            "telephone_number": "708-478-5694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 W EXCHANGE ST",
            "city": "CRETE",
            "state": "IL",
            "postal_code": "604172139",
            "telephone_number": "708-672-5431",
            "fax_number": "708-672-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF CRETE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "WATERMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "708-672-5431"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "7314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL OWCP",
            "identifier": "278720500",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9970504",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "590001912",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crete Fire Department",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Crete Fire Department",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Trilogy Healthcare of Will, LLC (St. James Manor and Villas)
• Uniquely Resilient PLLC
• Douglas Van Til, LCSW
• Veld Vision Center
• Paul A Veld, O.D.
• Vip Labs LLC.
• Vivid Cranial Prosthetics
• Nerissa Vogt, LSW
• Sophilia Walker
• Megan Wall

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; 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.