City of East Peoria

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

2968 Issued in IL

Legal business name

CITY OF EAST PEORIA

Practice address

201 W Washington St
East Peoria, IL 61611-2416

Phone

(309) 698-4740

Fax

(309) 698-4725

NPI assigned

Jul 19, 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

Michael Vaughn

Title

Fire Chief

Phone

(309) 698-4740

Specialties & licenses 1

Addresses

Other identifiers 2

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": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1285653485",
    "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": "201 W WASHINGTON ST",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112416",
            "telephone_number": "309-698-4740",
            "fax_number": "309-698-4725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF EAST PEORIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "309-698-4740"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "2968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9020610",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "690333345001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Melissa Clayton
• Cheryl Marie Cline
• Brandy J Coleman, APRN
• Comfort Care Medical Supply & Mattress
• Michael Connolly

• Land Ambulance in East Peoria, IL
• Providers in East Peoria, 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.