NPIMap

Organization Active NPI

Galesburg Hospitals' Ambulance Service

  • Ambulance
  • Galesburg, IL
National Provider Identifier
1528051752
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
022603 Issued in IL
Legal business name
GALESBURG HOSPITALS' AMBULANCE SERVICE
Practice address
2175 Windish Dr
Galesburg, IL 61401-9776
Phone
(309) 342-5144
Fax
(309) 342-4834
NPI assigned
Aug 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2012

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

Authorized official

Name
Michael E Wignall
Title
Accountant
Phone
(309) 342-5144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X 022603 IL Primary
Land Ambulance 3416L0300X 2603 IL

Addresses

Primary practice location

2175 Windish Dr
Galesburg, IL 61401-9776

Mailing address

2175 Windish Dr
Galesburg, IL 61401-9776
Phone (309) 342-5144

Other identifiers 2

IdentifierTypeStateIssuer
14D0889590OtherILCLIA
0004870049OtherILBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100219000265 IL Part B Supplier - Ambulance Service Supplier 4486798022 Practice locations: Galesburg, IL

National Provider Directory

National Provider Directory

Locations

2175 Windish Dr
Galesburg, IL 61401
Phone (309) 342-5144

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1528051752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2175 WINDISH DR",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614019776",
            "telephone_number": "309-342-5144",
            "fax_number": "309-342-4834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 WINDISH DR",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614019776",
            "telephone_number": "309-342-5144",
            "fax_number": "309-342-4834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALESBURG HOSPITALS' AMBULANCE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "WIGNALL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "309-342-5144"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": "022603",
            "primary": true
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "2603",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D0889590",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0004870049",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Galesburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; 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.