Provider Demographics
NPI:1346379989
Name:TONICA VOLUNTEER FIRE DEPT
Entity Type:Organization
Organization Name:TONICA VOLUNTEER FIRE DEPT
Other - Org Name:TONICA VOLUNTEER FIRE DEPT AND AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-442-3527
Mailing Address - Street 1:507 N FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:TONICA
Mailing Address - State:IL
Mailing Address - Zip Code:61370-9456
Mailing Address - Country:US
Mailing Address - Phone:815-442-3527
Mailing Address - Fax:815-442-3527
Practice Address - Street 1:507 N FIRST STREET
Practice Address - Street 2:
Practice Address - City:TONICA
Practice Address - State:IL
Practice Address - Zip Code:61370-9456
Practice Address - Country:US
Practice Address - Phone:815-442-3527
Practice Address - Fax:815-442-3527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05032035OtherBLUE CROSS BLUE SHIELD
IL210010Medicare ID - Type Unspecified