MEDICARE: ATS MEDICAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance
2	3416L0300X	Land Ambulance	12521	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212092	OTHER	IL	MEDICARE
3	M300047776	OTHER	IN	MEDICARE ID-TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	720345	OTHER	IN	ANTHEM BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639285414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATS MEDICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 771803
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-1803
Country	:	US
Telephone Number	:	815-963-6885
Fax Number	:	815-639-9521

Provider Business Practice Location Address
First Line	:	1752 WINDSOR LAKE PARKWAY
Second Line	:	SUITE 108
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4276
Country	:	US
Telephone Number	:	317-542-1111
Fax Number	:	707-703-4619

Authorized Official
Title or Position	:	CHIEF ADMIN OFFICER/CHIEF COMP
Name	:	KATHLEEN LOYA
Credential	:
Telephone Number	:	707-992-1263

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	06/03/2021

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Directions to “ATS MEDICAL SERVICES, LLC ” Practice Location

Language	Start Address	Practice Location

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