Leroy Emergency Ambulance Service Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

36734 Issued in IL

Legal business name

LEROY EMERGENCY AMBULANCE SERVICE INC

Practice address

303 S East St
Le Roy, IL 61752-1869

Phone

(309) 962-6114

Fax

(309) 962-5054

NPI assigned

Feb 2, 2007

Organization subpart

Yes

Parent organization

LEROY EMERGENCY AMBULANCE SERVICE INCAs reported in NPPES

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

Authorized official

Name

Laura Willis

Title

Administrator

Phone

(309) 962-6114

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• LeRoy Emergency Ambulance Service Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Part of

Leroy Emergency Amb SRV Inc

Locations

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1528106366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36",
            "city": "LE ROY",
            "state": "IL",
            "postal_code": "617520036",
            "telephone_number": "309-962-6114",
            "fax_number": "309-962-5054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 S EAST ST",
            "city": "LE ROY",
            "state": "IL",
            "postal_code": "617521869",
            "telephone_number": "309-962-6114",
            "fax_number": "309-962-5054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEROY EMERGENCY AMBULANCE SERVICE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEROY EMERGENCY AMBULANCE SERVICE INC",
        "enumeration_date": "2007-02-02",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "309-962-6114"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "36734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "791590694",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05730181",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LeRoy Emergency Ambulance Service Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LeRoy Emergency Ambulance Service Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John F. Couillard, O.D.
• Bethann Kaeb, COTA/L
• Brenda A. Kube, M.D.
• Patricia Lynn Larkin, M.S., CCC-SLP/L
• Leroy Community School District 2
• Kendra McKean, OTR
• Benjamin S Roth
• Srisai RX Mart LLC
• Srirat Temiyasathit, M.D.
• Jennifer Lynn Thomison, D.T.

• Land Ambulance in Le Roy, IL
• Providers in Le Roy, IL by specialty
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.