City of Moline

Primary specialty

AmbulanceTaxonomy code 341600000X

License

02253702 Issued in IL

Legal business name

CITY OF MOLINE

Practice address

1630 8TH Ave
Moline, IL 61265-2116

Phone

(309) 524-2250

Fax

(309) 524-2270

NPI assigned

Jun 30, 2005

Organization subpart

No

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

Authorized official

Name

Ivan Luverne Sederstrom

Title

Deputy Fire Chief

Phone

(309) 524-2257

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1760489199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 8TH AVENUE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612652116",
            "telephone_number": "309-524-2250",
            "fax_number": "309-524-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 8TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612652116",
            "telephone_number": "309-524-2250",
            "fax_number": "309-524-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF MOLINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "SEDERSTROM",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "LUVERNE",
        "authorized_official_title_or_position": "DEPUTY FIRE CHIEF",
        "authorized_official_telephone_number": "309-524-2257"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": "22537",
            "primary": false
        },
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": "02253702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "590918082",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0977744",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly A Christensen, OTR/L
• Ronald G. Christensen, ED.D; CADC
• Natalie Ann Christenson
• John C Ciaccio, MD
• Natalie Circello
• Charmaine Clark
• Jason Craig Clark, M.D.
• Rebekah Ann Clark, LPHA,LCSW
• Mara M Clarke, NPC
• Diann M Clem, DPT

• All providers in Moline, IL
• Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.