Organization
CITY OF MENDOTA
Active
Other names
Mendota Fire & EMS
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS J RUTISHAUSER (CHIEF)
(815) 539-3434
Entity
Organization
Contact information
Practice address
610 MAIN STREET, MENDOTA, IL 61342-1629
(815) 539-3434
(815) 538-2942
Mailing address
610 MAIN STREET, MENDOTA, IL 61342-1629
(815) 539-3434
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
1 2580
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005090011
BLUE CROSS BLUE SHIELD
IL
01
—
590009455
RAILROAD MEDICARE
IL
Enumeration date
08/28/2006
Last updated
09/08/2011
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