Provider Demographics
NPI:1083136261
Name:MAZON VERONA KINSMAN RESCUE SQUAD DISTRICT
Entity Type:Organization
Organization Name:MAZON VERONA KINSMAN RESCUE SQUAD DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-228-2488
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:800-244-2345
Mailing Address - Fax:800-329-5274
Practice Address - Street 1:604 FRONT ST
Practice Address - Street 2:
Practice Address - City:MAZON
Practice Address - State:IL
Practice Address - Zip Code:60444000
Practice Address - Country:US
Practice Address - Phone:815-448-2134
Practice Address - Fax:815-448-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport