Provider Demographics
NPI:1619139409
Name:ATKINSON FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:ATKINSON FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:MARYCLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-936-7220
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:PO BOX 140
Mailing Address - City:ATKINSON
Mailing Address - State:IL
Mailing Address - Zip Code:61235-0140
Mailing Address - Country:US
Mailing Address - Phone:309-936-7979
Mailing Address - Fax:
Practice Address - Street 1:101 E HENRY ST
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:IL
Practice Address - Zip Code:61235-7713
Practice Address - Country:US
Practice Address - Phone:309-936-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL02-25173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL942930OtherMEDICARE PROVIDER