# VILLAGE OF SOUTH JACKSONVILLE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245488857
- **Authorized official:** MR. DAVID A HICKOX (FIRE CHIEF)
- **Authorized official phone:** (217) 245-4803

## Contact information

- **Practice address:** 301 DEWEY DR, JACKSONVILLE, IL 62650-3206
- **Practice address phone:** (217) 245-4803
- **Mailing address:** PO BOX 42, MANCHESTER, IL 62663-0042
- **Mailing address phone:** (217) 587-4761
- **Mailing address fax:** (217) 587-2101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 341600000X | IL | Yes |

## Other

- **Enumeration date:** 09/08/2008
- **Last updated:** 12/30/2008