Img Ambulance LLC
Organization Active NPI Land Ambulance · Lake Bluff, IL
NPI 1336745637 · NPPES record last updated Oct 20, 2023
Key facts
- NPI
- 1336745637
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- IMG AMBULANCE LLC
- Practice address
- 28915 N Herky Dr Ste 103
Lake Bluff, IL 60044-1466 - Phone
- (847) 687-2241
- NPI assigned
- Dec 10, 2020
- Organization subpart
- No
Authorized official
- Name
- Konstantin Kipiani
- Title
- Owner
- Phone
- (847) 687-2241
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210805003158 | IL | Part B Supplier - Ambulance Service Supplier | 8921402462 | Practice locations: Lake Bluff, IL; McHenry, IL |
National Provider Directory
Locations
1095 Pingree Rd
Ste 101
Crystal Lake, IL 60014
Phone (816) 526-3634
3319 S State Route 31
Crystal Lake, IL 60012
28915 N Herky Dr
Ste 103
Lake Bluff, IL 60044
Phone (844) 464-2626
4519 Prime Pkwy
McHenry, IL 60050
741 Ridgeview Dr
McHenry, IL 60050
Phone (815) 526-3634
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
28915 N Herky Dr Ste 103
Lake Bluff, IL 60044-1466
Mailing address
28915 N Herky Dr Ste 103
Lake Bluff, IL 60044-1466
Phone (847) 687-2241
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.