Provider Demographics
NPI:1629024807
Name:VILLAGE OF MORTON
Entity Type:Organization
Organization Name:VILLAGE OF MORTON
Other - Org Name:MORTON FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-266-9001
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-0103
Mailing Address - Country:US
Mailing Address - Phone:309-266-9001
Mailing Address - Fax:309-266-6782
Practice Address - Street 1:300 W COURTLAND ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1409
Practice Address - Country:US
Practice Address - Phone:309-266-9001
Practice Address - Fax:309-266-6782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590005540OtherMEDICARE RAILROAD
IL090-70932OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL912670Medicare ID - Type Unspecified