Organization
BRADFORD RESCUE SQUAD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON STOTLER (PRESIDENT)
(309) 493-5112
Entity
Organization
Contact information
Practice address
241 W MAIN STREET, BRADFORD, IL 61421-0040
(309) 682-5280
(309) 682-5327
Mailing address
PO BOX 40, 241 W MAIN STREET, BRADFORD, IL 61421-0020
(309) 682-5280
(309) 682-5327
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08832003
BLUE CROSS
IL
01
—
P00227106
PALMETTO GBA
IL
Enumeration date
02/09/2007
Last updated
08/22/2020
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