City of Mendota
Organization Active NPI Ambulance · Mendota, IL
NPI 1619085842 · NPPES record last updated Sep 8, 2011
Key facts
- NPI
- 1619085842
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- License
- 1 2580 (IL)
- Legal business name
- CITY OF MENDOTA
- Practice address
- 610 Main Street
Mendota, IL 61342-1629 - Phone
- (815) 539-3434
- Fax
- (815) 538-2942
- NPI assigned
- Aug 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Dennis J Rutishauser
- Title
- Chief
- Phone
- (815) 539-3434
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120315000742 | IL | Part B Supplier - Ambulance Service Supplier | 9931368610 | Practice locations: Mendota, IL |
National Provider Directory
Locations
610 Main St
Mendota, IL 61342
Phone (815) 539-3434
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 1 2580 | IL | Yes |
Addresses
Primary practice location
610 Main Street
Mendota, IL 61342-1629
Mailing address
610 Main Street
Mendota, IL 61342-1629
Phone (815) 539-3434
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 590009455 | Other | IL | RAILROAD MEDICARE |
| 0005090011 | Other | IL | BLUE CROSS BLUE SHIELD |
Other names
- Mendota Fire & EMS
Other providers in Mendota, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2011. 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.