Provider Demographics
NPI:1619085842
Name:CITY OF MENDOTA
Entity Type:Organization
Organization Name:CITY OF MENDOTA
Other - Org Name:MENDOTA FIRE & EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUTISHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-539-3434
Mailing Address - Street 1:610 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-1629
Mailing Address - Country:US
Mailing Address - Phone:815-539-3434
Mailing Address - Fax:
Practice Address - Street 1:610 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-1629
Practice Address - Country:US
Practice Address - Phone:815-539-3434
Practice Address - Fax:815-538-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1 2580341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590009455OtherRAILROAD MEDICARE
IL0005090011OtherBLUE CROSS BLUE SHIELD
IL590009455OtherRAILROAD MEDICARE
IL=========001Medicaid