Trace Ambulance Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

7949 Issued in IL

Legal business name

TRACE AMBULANCE INC

Practice address

8400 183Rd PL
Tinley Park, IL 60477-9268

Phone

(708) 614-1343

Fax

(708) 633-1622

NPI assigned

May 20, 2006

Organization subpart

Yes

Parent organization

AMB TRAN GROUP, LTDAs reported in NPPES

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

Authorized official

Name

Mr. Christopher J Vandenberg

Title

President

Phone

(708) 614-1343

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1730133166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8400 183RD PL",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604879205",
            "telephone_number": "708-614-1343",
            "fax_number": "708-570-1652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8400 183RD PL",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604779268",
            "telephone_number": "708-614-1343",
            "fax_number": "708-633-1622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACE AMBULANCE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMB TRAN GROUP, LTD",
        "enumeration_date": "2006-05-20",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "VANDENBERG",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-614-1343",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "7949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0099220355",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0005110113",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590010440",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "995737",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; 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.