Provider Demographics
NPI:1083764880
Name:WALNUT FIRE DEPARTMENT INC
Entity Type:Organization
Organization Name:WALNUT FIRE DEPARTMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESCUE CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-379-9257
Mailing Address - Street 1:115 LIBERTY STREET P.O. BOX 277
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:IL
Mailing Address - Zip Code:61376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:IL
Practice Address - Zip Code:61376
Practice Address - Country:US
Practice Address - Phone:815-379-2341
Practice Address - Fax:815-379-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL28953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport