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Organization

BLUEGRASS FIRE PROTECTION DISTRICT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RANDY H NIVER EMT (EMS COORDINATOR)
(217) 987-6560
Entity
Organization

Contact information

Practice address
125 N LOGAN ST., POTOMAC, IL 61865-0260
(217) 987-6560
(855) 243-5633
Mailing address
P.O. BOX 260, POTOMAC, IL 61865-0260
(217) 987-6560
(855) 243-5633

Taxonomy

Speciality
Code
Description
License number
State
341600000X
Ambulance
006764
IL
341600000X
Ambulance
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
09270870
BLUE CROSS
05
37600239001
IL
01
590014094
RR MEDICARE
Enumeration date
11/01/2006
Last updated
09/09/2015
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