Village of Peoria Heights

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

22572 Issued in IL

Legal business name

VILLAGE OF PEORIA HEIGHTS

Doing business as

Peoria Heights Ambulance Service

Practice address

4901 N Prospect Rd
Peoria Heights, IL 61616-5397

Phone

(309) 686-2370

Fax

(309) 682-3089

NPI assigned

Mar 1, 2007

Last updated

Apr 23, 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

James Marotta

Title

Ambulance Administrator

Phone

(309) 686-2386

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• PEORIA HEIGHTS AMBULANCE SERVICE Doing business as

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335139200000",
    "number": "1427186584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 457",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600900457",
            "telephone_number": "847-577-8811",
            "fax_number": "847-577-3518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 N PROSPECT RD",
            "city": "PEORIA HEIGHTS",
            "state": "IL",
            "postal_code": "616165397",
            "telephone_number": "309-686-2370",
            "fax_number": "309-682-3089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF PEORIA HEIGHTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2012-04-23",
        "status": "A",
        "authorized_official_last_name": "MAROTTA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "AMBULANCE ADMINISTRATOR",
        "authorized_official_telephone_number": "309-686-2386"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "22572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "07232092",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590006195",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEORIA HEIGHTS AMBULANCE SERVICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer A Siefert, RPH
• Jamie Lynn Smith, D.D.S., M.S.
• Kevin Spangler, APN
• Megan Stickelmaier, LCSW
• Molly K. Suellentrop, COTA/L
• Caitlyn Clare Wagenbach, PA-C
• Walgreen Co (Walgreens #05544)
• Stephanie K Weir, LCPC
• Jeffrey Scott Whitson, DMD
• Kim Arthur Wickwire, D.C.

• Land Ambulance in Peoria Heights, IL
• Providers in Peoria Heights, IL by specialty
• Land Ambulance in Illinois

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