Organization
NEW MILFORD FIRE AMBULANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN RYAN TRAIL (DEPUTY CHIEF OF EMS)
(815) 874-4880
Entity
Organization
Contact information
Practice address
2177 WILL JAMES RD, ROCKFORD, IL 61109-4854
(815) 235-2353
Mailing address
2177 WILL JAMES RD, ROCKFORD, IL 61109-4854
(815) 874-4880
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1506544
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10170774
BLUE CROSS SHIELD OF IL
IL
05
—
363298101001
—
IL
01
—
990007591
RAILROAD MEDICARE
IL
Enumeration date
03/28/2007
Last updated
03/01/2018
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