City of Rock Island

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

02 2511 Issued in IL

Legal business name

CITY OF ROCK ISLAND

Doing business as

Rock Island Ambulance Service

Practice address

1313 5TH Ave
Rock Island, IL 61201-8523

Phone

(309) 732-2800

Fax

(309) 732-2813

NPI assigned

Dec 1, 2006

Last updated

Jul 25, 2017By 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

Jeffrey Carl Yerkey

Title

Fire Chief

Phone

(309) 732-2801

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ROCK ISLAND AMBULANCE SERVICE Doing business as

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": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500940800000",
    "number": "1962570507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 5TH AVE",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612018523",
            "telephone_number": "309-732-2800",
            "fax_number": "309-732-2813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 5TH AVE",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612018523",
            "telephone_number": "309-732-2800",
            "fax_number": "309-732-2813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF ROCK ISLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2017-07-25",
        "status": "A",
        "authorized_official_last_name": "YERKEY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "CARL",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "309-732-2801"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "02 2511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0994988",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "590003477",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ROCK ISLAND AMBULANCE SERVICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Suzanne Chukas, MA
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• Andrea Mae Clark, MSW, LSW
• Jay Clark, ATC
• Stephanie Clark
• Ryan M Clarke, MSPT

• Land Ambulance in Rock Island, IL
• Providers in Rock Island, 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 25, 2017; 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.