Amboy Fire Protection District
Organization Active NPI Land Ambulance · Amboy, IL
NPI 1508992439 · NPPES record last updated Sep 9, 2015
Key facts
- NPI
- 1508992439
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 151883 (IL)
- Legal business name
- AMBOY FIRE PROTECTION DISTRICT
- Practice address
- 25 N East Ave
Amboy, IL 61310-1330 - Phone
- (815) 857-2325
- Fax
- (815) 857-2066
- NPI assigned
- Feb 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeff Bryant I
- Title
- Fire Chief
- Phone
- (815) 857-2325
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2222320 | Amboy Fire Protection District | Certificate of waiver | Apr 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040426000789 | IL | Part B Supplier - Ambulance Service Supplier | 9739175522 | Practice locations: Amboy, IL |
National Provider Directory
Locations
25 N East Ave
Amboy, IL 61310
Phone (815) 857-2325
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 151883 | IL | Yes |
Addresses
Primary practice location
25 N East Ave
Amboy, IL 61310-1330
Mailing address
PO Box 260
Mendota, IL 61342-0260
Phone (815) 539-2468
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 590028249 | Other | IL | RAILROAD MEDICARE |
Other providers in Amboy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2015. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.