Provider Demographics
NPI:1437276318
Name:TREMONT 702 RESCUE SQUAD
Entity Type:Organization
Organization Name:TREMONT 702 RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-369-0515
Mailing Address - Street 1:300 S. SAMPSON ST.
Mailing Address - Street 2:
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-0111
Mailing Address - Country:US
Mailing Address - Phone:309-387-6819
Mailing Address - Fax:217-524-7232
Practice Address - Street 1:300 S. SAMPSON ST.
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:IL
Practice Address - Zip Code:61568-0111
Practice Address - Country:US
Practice Address - Phone:309-387-6819
Practice Address - Fax:217-524-7232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225943416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371036620001Medicaid
IL9032032OtherBLUE CROSS
IL9032032OtherBLUE CROSS