Organization
EARLVILLE COM FIRE PRO DIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT HANSEN (AMBULANCE DIRECTOR)
(815) 970-4921
Entity
Organization
Contact information
Practice address
99 N. EAST ST, EARLVILLE, IL 60518-8232
(815) 246-7095
(815) 246-7095
Mailing address
PO BOX 260, MENDOTA, IL 61342-0260
(815) 539-2468
(815) 539-6427
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
1 2554
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005032023
BLUE CROSS BLUE SHIELD
IL
05
—
362038712001
—
IL
01
—
590000937
RAILROAD MEDICARE
IL
Enumeration date
08/28/2006
Last updated
05/26/2016
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