NPIMap

Organization Active NPI

Roseville Area Ambulance SVC

  • Land Ambulance
  • Roseville, IL
National Provider Identifier
1598833915
Registry record updated Dec 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
02 2508 Issued in IL
Legal business name
ROSEVILLE AREA AMBULANCE SVC
Practice address
571 State Highway 116
Roseville, IL 61473-9666
Phone
(309) 426-1804
NPI assigned
Dec 1, 2006
Last updated
Dec 14, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2012

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

Authorized official

Name
Mary Ellen Adkisson
Title
President
Phone
(309) 337-3844

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 02 2508 IL Primary

Addresses

Primary practice location

571 State Highway 116
Roseville, IL 61473-9666

Mailing address

PO Box 551
Roseville, IL 61473-0551
Phone (309) 426-1804

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120806000054 IL Part B Supplier - Ambulance Service Supplier 8729234893 Practice locations: Roseville, IL

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355443200000",
    "number": "1598833915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551",
            "city": "ROSEVILLE",
            "state": "IL",
            "postal_code": "614730551",
            "telephone_number": "309-426-1804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "571 STATE HIGHWAY 116",
            "city": "ROSEVILLE",
            "state": "IL",
            "postal_code": "614739666",
            "telephone_number": "309-426-1804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEVILLE AREA AMBULANCE SVC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2012-12-14",
        "status": "A",
        "authorized_official_last_name": "ADKISSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-337-3844"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "02 2508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.