NPIMap

Organization Active NPI

Elizabeth Community Ambulance Service

  • Land Ambulance
  • Elizabeth, IL
National Provider Identifier
1245224138
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
1595013 Issued in IL
Legal business name
ELIZABETH COMMUNITY AMBULANCE SERVICE
Practice address
111 E Myrtle St
Elizabeth, IL 61028-9794
Phone
(815) 858-2404
NPI assigned
Sep 7, 2005
Last updated
Sep 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Authorized official

Name
E Rudy Pascoe
Title
Coordinator
Phone
(815) 858-2404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 1595013 IL Primary

Addresses

Primary practice location

111 E Myrtle St
Elizabeth, IL 61028-9794

Mailing address

111 E Myrtle St
P O Box 325
Elizabeth, IL 61028-9794
Phone (815) 858-2404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040602000665 IL Part B Supplier - Ambulance Service Supplier 5799767976 Practice locations: Elizabeth, IL

National Provider Directory

National Provider Directory

Locations

111 E Myrtle St
Elizabeth, IL 61028
Phone (815) 266-3863

NPI Registry JSON

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1245224138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E MYRTLE ST",
            "address_2": "P O BOX 325",
            "city": "ELIZABETH",
            "state": "IL",
            "postal_code": "610289794",
            "telephone_number": "815-858-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E MYRTLE ST",
            "city": "ELIZABETH",
            "state": "IL",
            "postal_code": "610289794",
            "telephone_number": "815-858-2404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETH COMMUNITY AMBULANCE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "PASCOE",
        "authorized_official_first_name": "E",
        "authorized_official_middle_name": "RUDY",
        "authorized_official_title_or_position": "COORDINATOR",
        "authorized_official_telephone_number": "815-858-2404"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "1595013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.