New Boston Volunteer Ambulance Service, Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

22540 Issued in IL

Legal business name

NEW BOSTON VOLUNTEER AMBULANCE SERVICE, INC

Practice address

602 Broadway
New Boston, IL 61272-0066

Phone

(309) 587-8213

Fax

(309) 587-2029

NPI assigned

Mar 15, 2007

Last updated

Dec 29, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donald E Bacon

Title

Secretary/Treasurer

Phone

(309) 587-8213

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": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325116800000",
    "number": "1881728459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 WASHINGTON",
            "city": "NEW BOSTON",
            "state": "IL",
            "postal_code": "612720066",
            "telephone_number": "309-587-8213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 BROADWAY",
            "city": "NEW BOSTON",
            "state": "IL",
            "postal_code": "612720066",
            "telephone_number": "309-587-8213",
            "fax_number": "309-587-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW BOSTON VOLUNTEER AMBULANCE SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2011-12-29",
        "status": "A",
        "authorized_official_last_name": "BACON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "309-587-8213"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NU",
            "license": "22540",
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "22540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590003560",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "06632003",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Saey

• Land Ambulance in New Boston, IL
• Providers in New Boston, IL by specialty
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; 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.