NPIMap

Organization Active NPI

Prairieland Community Ambulance Service Co

  • Land Ambulance
  • Virden, IL
National Provider Identifier
1770617748
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
3643 Issued in IL
Legal business name
PRAIRIELAND COMMUNITY AMBULANCE SERVICE CO
Practice address
610 S Springfield St
Virden, IL 62690-0023
Phone
(217) 965-5999
Fax
(217) 965-5714
NPI assigned
Mar 14, 2007
Last updated
Oct 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Authorized official

Name
John Earley
Title
Board President
Phone
(217) 899-3135

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X 33643 IL
Land Ambulance 3416L0300X 3643 IL Primary

Addresses

Primary practice location

610 S Springfield St
Virden, IL 62690-0023

Mailing address

PO Box 23
Virden, IL 62690-0023
Phone (217) 965-5999

Other identifiers 2

IdentifierTypeStateIssuer
613448800OtherILDOL/OWEP
0005932045OtherILBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080808000121 IL Part B Supplier - Ambulance Service Supplier 3476627480 Practice locations: Virden, IL

National Provider Directory

National Provider Directory

Locations

304 S Springfield St
Virden, IL 62690

610 S Springfield St
Virden, IL 62690
Phone (217) 965-5999

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698192000000",
    "number": "1770617748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23",
            "city": "VIRDEN",
            "state": "IL",
            "postal_code": "626900023",
            "telephone_number": "217-965-5999",
            "fax_number": "217-965-5714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 S SPRINGFIELD ST",
            "city": "VIRDEN",
            "state": "IL",
            "postal_code": "626900023",
            "telephone_number": "217-965-5999",
            "fax_number": "217-965-5714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIELAND COMMUNITY AMBULANCE SERVICE CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A",
        "authorized_official_last_name": "EARLEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "BOARD PRESIDENT",
        "authorized_official_telephone_number": "217-899-3135"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": "33643",
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "3643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL/OWEP",
            "identifier": "613448800",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0005932045",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virden, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.