Tri-County Ambulance District
Organization Active NPI Land Ambulance · Rio, IL
NPI 1508891367 · NPPES record last updated Apr 26, 2024
Key facts
- NPI
- 1508891367
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 2606 (IL)
- Legal business name
- TRI-COUNTY AMBULANCE DISTRICT
- Practice address
- 2495 Shepherd Dr
Rio, IL 61472-9802 - Phone
- (309) 337-4272
- NPI assigned
- Jul 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Scott Roger Lake
- Title
- Director
- Phone
- (309) 337-4272
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040415000777 | IL | Part B Supplier - Ambulance Service Supplier | 6901891456 | Practice locations: Alpa, IL; Woodhull, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 2606 | IL | Yes |
Addresses
Primary practice location
2495 Shepherd Dr
Rio, IL 61472-9802
Mailing address
PO Box 97
Woodhull, IL 61490-0097
Phone (309) 337-4272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 370999628001 | Medicaid | IL |
Other providers in Rio, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.