Little Mackinaw Fire District

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

LITTLE MACKINAW FIRE DISTRICT

Doing business as

Minier Ambulance Service

Practice address

107 E. Central
Box 680
Minier, IL 61759-0680

Phone

(309) 392-2112

Fax

(309) 392-2112

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Jaclyn Mortimer

Title

Chief

Phone

(309) 678-5035

Specialties & licenses 1

Addresses

Other names 1

• MINIER AMBULANCE SERVICE Doing business as

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": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635897600000",
    "number": "1770629073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 680",
            "address_2": "107 E CENTRAL",
            "city": "MINIER",
            "state": "IL",
            "postal_code": "617590680",
            "telephone_number": "309-392-2112",
            "fax_number": "309-392-2112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E. CENTRAL",
            "address_2": "BOX 680",
            "city": "MINIER",
            "state": "IL",
            "postal_code": "617590680",
            "telephone_number": "309-392-2112",
            "fax_number": "309-392-2112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE MACKINAW FIRE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A",
        "authorized_official_last_name": "MORTIMER",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "309-678-5035"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MINIER AMBULANCE SERVICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MINIER AMBULANCE SERVICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janet Bodnar, DC
• Hillary Kay Watkins, FNP

• Land Ambulance in Minier, IL
• Providers in Minier, IL by specialty
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; 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.