Stephen & Fred Shrader PTR

Primary specialty

AmbulanceTaxonomy code 341600000X

License

670002 Issued in IL

Legal business name

STEPHEN & FRED SHRADER PTR

Practice address

204 N Locust St
Arcola, IL 61910-1407

Phone

(217) 268-4848

NPI assigned

Jan 5, 2007

Last updated

Jan 24, 2012By 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

Mrs. Connie Shrader

Title

Owner

Phone

(217) 268-4848

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shrader Ambulance Service Other name

Locations

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327363200000",
    "number": "1366599854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277",
            "address_2": "204 N. LOCUST ST",
            "city": "ARCOLA",
            "state": "IL",
            "postal_code": "619100277",
            "telephone_number": "217-268-4848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 N LOCUST ST",
            "city": "ARCOLA",
            "state": "IL",
            "postal_code": "619101407",
            "telephone_number": "217-268-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN & FRED SHRADER PTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2012-01-24",
        "status": "A",
        "authorized_official_last_name": "SHRADER",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-268-4848",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": "670002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "2190002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shrader Ambulance Service",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Ambulance in Arcola, IL
• Providers in Arcola, IL by specialty
• Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.