Provider Demographics
NPI:1306017256
Name:DANVERS EMERGENCY & RESCUE SERVICE
Entity Type:Organization
Organization Name:DANVERS EMERGENCY & RESCUE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LITWILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-963-4048
Mailing Address - Street 1:208 E. MAIN ST.
Mailing Address - Street 2:P. O. BOX 524
Mailing Address - City:DANVERS
Mailing Address - State:IL
Mailing Address - Zip Code:61732
Mailing Address - Country:US
Mailing Address - Phone:309-963-4048
Mailing Address - Fax:309-963-4048
Practice Address - Street 1:208 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:IL
Practice Address - Zip Code:61732-9197
Practice Address - Country:US
Practice Address - Phone:309-963-4048
Practice Address - Fax:309-963-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL676601261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL696860Medicare PIN