Peoria Non- Emergency Medical Transport

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Legal business name

PEORIA NON- EMERGENCY MEDICAL TRANSPORT

Practice address

3624 W Cassadaga CT
Peoria, IL 61615-3952

Phone

(309) 857-1165

NPI assigned

Nov 8, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Cory E. WallaceNPI 1871483420

Title

Owner/Operator

Phone

(309) 857-1165

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cory Edward Wallace

  • Non-emergency Medical Transport (VAN)
  • Peoria, IL
  • NPI 1871483420
  NPD Authorized official

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636329600000",
    "number": "1376208983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 W CASSADAGA CT",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616153952",
            "telephone_number": "309-857-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 W CASSADAGA CT",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616153952",
            "telephone_number": "309-857-1165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA NON- EMERGENCY MEDICAL TRANSPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-08",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "309-857-1165",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Non-emergency Medical Transport (VAN) in Peoria, IL
• Providers in Peoria, IL by specialty
• Non-emergency Medical Transport (VAN) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; 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.