City of Mascoutah

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

4851 Issued in IL

Legal business name

CITY OF MASCOUTAH

Practice address

3 W Main St
Mascoutah, IL 62258-2030

Phone

(800) 538-8278

Fax

(580) 628-2273

NPI assigned

Oct 26, 2006

Last updated

Jun 23, 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

Jeremy Gottschammer

Title

Supervisor

Phone

(800) 538-8278

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mascoutah Ambulance Service 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": "1214179200000",
    "number": "1346325701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 W MAIN ST",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622582030",
            "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": "3 W MAIN ST",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622582030",
            "telephone_number": "800-538-8278",
            "fax_number": "580-628-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF MASCOUTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "GOTTSCHAMMER",
        "authorized_official_first_name": "JEREMY",
        "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": "4851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC PROVIDER NUMBER",
            "identifier": "590007593",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "8273216",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mascoutah Ambulance Service",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kristen Bruton, LCPC
• Brandy D Bryant, LCSW
• Butler Therapy Services PC
• Heidi Calvert, RPH
• Chiropractic & Spinal Care Clinic of Mascoutah
• Bertha Denise Clark, CFLE
• Community Care Center of Mascoutah, Inc. (Mar-Ka Nursing Home)
• Community Residence, Inc. (Silver Creek Rehabilitation)
• Allyson Corry
• Jillian Raine Crump

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.