Provider Demographics
NPI:1073554341
Name:MINOOKA FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:MINOOKA FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:YANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-467-5637
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-0736
Mailing Address - Country:US
Mailing Address - Phone:815-467-5637
Mailing Address - Fax:815-467-5453
Practice Address - Street 1:413 W MONDAMIN
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447
Practice Address - Country:US
Practice Address - Phone:815-467-5637
Practice Address - Fax:847-577-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3222002OtherBCBS
IL3222002OtherBCBS
IL=========001Medicaid
IL=========OtherTRICARE NORTH