Organization
CITY OF EAST PEORIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL VAUGHN (FIRE CHIEF)
(309) 698-4740
Entity
Organization
Contact information
Practice address
201 W WASHINGTON ST, EAST PEORIA, IL 61611-2416
(309) 698-4740
(309) 698-4725
Mailing address
PO BOX 457, WHEELING, IL 60090-0457
(847) 577-8811
(847) 577-7967
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
2968
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
690333345001
—
IL
01
—
9020610
BCBS
IL
Enumeration date
07/19/2006
Last updated
04/20/2008
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