United Life Care Amb SVC Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

66550 Issued in IL

Legal business name

UNITED LIFE CARE AMB SVC INC

Practice address

301 S Cross St
Robinson, IL 62454-2155

Phone

(618) 544-3911

Fax

(724) 234-4703

NPI assigned

Jul 20, 2006

Organization subpart

No

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

Authorized official

Name

Andrew Hargrave

Title

President

Phone

(618) 562-1193

Specialties & licenses 1

Addresses

Other identifiers 3

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": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1912927385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S CROSS ST",
            "city": "ROBINSON",
            "state": "IL",
            "postal_code": "624542155",
            "telephone_number": "618-544-3911",
            "fax_number": "724-234-4703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S CROSS ST",
            "city": "ROBINSON",
            "state": "IL",
            "postal_code": "624542155",
            "telephone_number": "618-544-3911",
            "fax_number": "724-234-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED LIFE CARE AMB SVC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "HARGRAVE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-562-1193"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "66550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590013091",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LBOR",
            "identifier": "610886400",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0001723897",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Robinson, IL
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; 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.