Provider Demographics
NPI:1235247594
Name:NEWARK FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:NEWARK FIRE PROTECTION DISTRICT
Other - Org Name:NEWARK FIRE PROTECTION DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIERZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-695-5291
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-0260
Mailing Address - Country:US
Mailing Address - Phone:815-539-2468
Mailing Address - Fax:815-539-6427
Practice Address - Street 1:101 E. MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:IL
Practice Address - Zip Code:60541-0577
Practice Address - Country:US
Practice Address - Phone:815-695-5147
Practice Address - Fax:815-695-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1 7145341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004732059OtherBLUE CROSS / BLUE SHIELD
IL=========001Medicaid
IL0004732059Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IL214349Medicare ID - Type Unspecified