Provider Demographics
NPI:1497753917
Name:PRAIRIE EMERGENCY SERVICES, SC
Entity Type:Organization
Organization Name:PRAIRIE EMERGENCY SERVICES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAO
Authorized Official - Middle Name:
Authorized Official - Last Name:KILARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-726-6860
Mailing Address - Street 1:PO BOX 635225
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0043
Mailing Address - Country:US
Mailing Address - Phone:815-726-6860
Mailing Address - Fax:815-726-6861
Practice Address - Street 1:333 MADISON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8200
Practice Address - Country:US
Practice Address - Phone:815-725-7133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
318290Medicare ID - Type Unspecified