Provider Demographics
NPI:1417023433
Name:NEOGA FIRE PROTECTION DISTRICT NO 1
Entity Type:Organization
Organization Name:NEOGA FIRE PROTECTION DISTRICT NO 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-895-3349
Mailing Address - Street 1:757 CHESTNUT
Mailing Address - Street 2:PO BOX 666
Mailing Address - City:NEOGA
Mailing Address - State:IL
Mailing Address - Zip Code:62447
Mailing Address - Country:US
Mailing Address - Phone:217-895-3349
Mailing Address - Fax:217-895-3911
Practice Address - Street 1:757 CHESTNUT
Practice Address - Street 2:
Practice Address - City:NEOGA
Practice Address - State:IL
Practice Address - Zip Code:62447
Practice Address - Country:US
Practice Address - Phone:217-895-3349
Practice Address - Fax:217-895-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL66501013416L0300X
IL66501023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1832002OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL212486Medicare ID - Type Unspecified