Organization
CITY OF PRINCETON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES J WOOLLEY (CHIEF)
(815) 875-1861
Entity
Organization
Contact information
Practice address
2 S MAIN ST, PRINCETON, IL 61356-1708
(815) 875-1861
(815) 879-2208
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 2588
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000670001
BLUE CROSS BLUE SHIELD
IL
01
—
590128834
RAILROAD MEDICARE
IL
Enumeration date
08/28/2006
Last updated
08/23/2016
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