Organization
GENOA-KINGSTON FIRE PROTECTION DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE KOZLOWSKI (FIRE CHIEF)
(815) 784-3412
Entity
Organization
Contact information
Practice address
309 E RAILROAD AVE, GENOA, IL 60135-1247
(815) 784-2300
Mailing address
317 E RAILROAD AVE, GENOA, IL 60135-1247
(815) 784-3412
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
1101601
IL
341600000X
Ambulance
1101602
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001915180
BLUE CROSS PROVIDER #
IL
01
—
590028238
RR/MC PROVIDER #
IL
Enumeration date
07/04/2006
Last updated
09/12/2012
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