City of Ofallon

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

4865 Issued in IL

Legal business name

CITY OF OFALLON

Practice address

285 N 7 Hills Rd
O Fallon, IL 62269-4110

Phone

(800) 538-8278

Fax

(580) 628-2273

NPI assigned

Oct 26, 2006

Organization subpart

No

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

Authorized official

Name

Jim Holley

Title

Supervisor

Phone

(800) 538-8278

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• OFALLON EMS 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": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1326123613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 N 7 HILLS RD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622694110",
            "telephone_number": "800-538-8278",
            "fax_number": "580-628-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 N 7 HILLS RD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622694110",
            "telephone_number": "800-538-8278",
            "fax_number": "580-628-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF OFALLON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "800-538-8278"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "4865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "0008220726",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC PROVIDER NUMBER",
            "identifier": "590009903",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OFALLON EMS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Christianne Judy LCSW LLC
• Christina H Dothager MD LLC (Serene Women's Wellness)
• Gregory Scott Churchill, PHYSICIAN ASSISTANT
• Connor R Cima
• Gerthy Cipus Pierre
• Belinda M. Clark, MA
• Kathryn J Clayton
• Kristopher Clements, CRNA
• Taylor Cleveland
• Gregorio Cesar Climaco VII, MD

• Land Ambulance in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; 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.