Provider Demographics
NPI:1477592798
Name:CITY OF OTTAWA ILLINOIS
Entity Type:Organization
Organization Name:CITY OF OTTAWA ILLINOIS
Other - Org Name:OTTAWA FIRE DEPARTMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-434-3785
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-0260
Mailing Address - Country:US
Mailing Address - Phone:815-539-2468
Mailing Address - Fax:815-539-6427
Practice Address - Street 1:301 W LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-5700
Practice Address - Country:US
Practice Address - Phone:815-434-3785
Practice Address - Fax:815-434-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL29633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05032006OtherBCBS
IL611185500OtherDOL / OWCP
IL590008306OtherRR MEDICARE
IL611185500OtherDOL / OWCP
IL=========OtherTRICARE NORTH
IL611185500OtherDOL / OWCP
IL200690Medicare PIN