Provider Demographics
NPI:1508992439
Name:AMBOY FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:AMBOY FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:815-857-2325
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 1:25 N EAST AVE
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:IL
Practice Address - Zip Code:61310-1330
Practice Address - Country:US
Practice Address - Phone:815-857-2325
Practice Address - Fax:815-857-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1518833416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590028249OtherRAILROAD MEDICARE
IL=========Medicaid
IL=========Medicaid