Blackhawk Medical Transportation, Inc.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

8959 Issued in IL

Legal business name

BLACKHAWK MEDICAL TRANSPORTATION, INC.

Practice address

8400 183Rd PL
Tinley Park, IL 60477-9268

Phone

(708) 532-1613

NPI assigned

May 27, 2006

Organization subpart

Yes

Parent organization

AMB TRAN GROUP, LTDAs reported in NPPES

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

Authorized official

Name

Mr. Christopher J Vandenberg

Title

Treasurer

Phone

(708) 532-1613

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• VANDENBERG AMBULANCE Doing business as

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": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1427005347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8400 183RD PL",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604879205",
            "telephone_number": "708-532-1613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8400 183RD PL",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604779268",
            "telephone_number": "708-532-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKHAWK MEDICAL TRANSPORTATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMB TRAN GROUP, LTD",
        "enumeration_date": "2006-05-27",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "VANDENBERG",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "708-532-1613",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "8959",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "IL",
            "license": "3459",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "8100050",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0004598029",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0009932136",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590013754",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VANDENBERG AMBULANCE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Land Ambulance in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; 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.