Shabbona Comm Fire District

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

1408 Issued in IL

Legal business name

SHABBONA COMM FIRE DISTRICT

Practice address

103 E Navaho Ave
Shabbona, IL 60550-5147

Phone

(815) 824-2115

Fax

(815) 824-2938

NPI assigned

Jul 9, 2006

Organization subpart

No

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

Authorized official

Name

Frank Ottengheime

Title

Fire Chief

Phone

(815) 824-2115

Specialties & licenses 1

Addresses

Other identifiers 2

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": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310947200000",
    "number": "1932132008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 260",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613420260",
            "telephone_number": "815-539-2468",
            "fax_number": "815-539-6427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 E NAVAHO AVE",
            "city": "SHABBONA",
            "state": "IL",
            "postal_code": "605505147",
            "telephone_number": "815-824-2115",
            "fax_number": "815-824-2938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHABBONA COMM FIRE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2011-07-18",
        "status": "A",
        "authorized_official_last_name": "OTTENGHEIME",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "815-824-2115"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "1408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1921562",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "590012025",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrzej Gasiorowski
• Health Progress, Inc.
• Indian Creek Cusd 425
• Prairie Crossing Assisted Living, LLC
• Prairie Crossing Living & Rehabilitation Center, LLC
• Shabbona Health Care Center
• Shabbona Helath Care Center
• Shabbona Supportive Living
• Shabbona Supportive Living
• Leslie Ward, M.A., SLP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.