Provider Demographics
NPI:1295852515
Name:CITY OF MINONK OF WOODFORD COUNTY
Entity Type:Organization
Organization Name:CITY OF MINONK OF WOODFORD COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-432-2730
Mailing Address - Street 1:670 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MINONK
Mailing Address - State:IL
Mailing Address - Zip Code:61760-1272
Mailing Address - Country:US
Mailing Address - Phone:309-432-2558
Mailing Address - Fax:309-432-3547
Practice Address - Street 1:636 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MINONK
Practice Address - State:IL
Practice Address - Zip Code:61760-1243
Practice Address - Country:US
Practice Address - Phone:309-432-2730
Practice Address - Fax:309-432-3547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590007853OtherRAILROAD MEDICARE
IL0010215109OtherBLUE CROSS
IL590007853OtherRAILROAD MEDICARE
IL=========001Medicaid