Active NPI
Gerald M Duffy Trust Uw
- Land Ambulance
- Pontiac, IL
National Provider Identifier
1932220829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 26718
- Legal business name
- GERALD M DUFFY TRUST UW
- Practice address
- 122 E Howard St
Pontiac, IL 61764-1918 - Phone
- (815) 844-7111
- Fax
- (815) 842-1061
- NPI assigned
- Apr 2, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Kristin M Pitte
- Title
- Trustee
- Phone
- (815) 844-7111
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 26718 | IL | Primary |
Addresses
Primary practice location
122 E Howard St
Pontiac, IL 61764-1918
Mailing address
202 E Howard St
Pontiac, IL 61764-1920
Phone (815) 844-7111
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5390001 | Other | IL | BLUE CROSS BLUE SHIELD |
| P00221706 | Other | IL | RAILROAD MEDICARE |
| 001803 | Other | IL | HEALTH ALLIANCE |
Other names 1
- Duffy Ambulance Service
National Provider Directory
National Provider DirectoryLocations
202 E Howard St
Pontiac, IL 61764
Phone (815) 844-7111
122 E Howard St
Pontiac, IL 61764
Phone (815) 842-1288
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1208649600000",
"number": "1932220829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 E HOWARD ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "617641920",
"telephone_number": "815-844-7111",
"fax_number": "815-842-1061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 E HOWARD ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "617641918",
"telephone_number": "815-844-7111",
"fax_number": "815-842-1061"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GERALD M DUFFY TRUST UW",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-02",
"last_updated": "2008-04-20",
"status": "A",
"authorized_official_last_name": "PITTE",
"authorized_official_first_name": "KRISTIN",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "TRUSTEE",
"authorized_official_telephone_number": "815-844-7111",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "IL",
"license": "26718",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "5390001",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00221706",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "001803",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Duffy Ambulance Service",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pontiac, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.