Provider Demographics
NPI:1629113071
Name:NORTHERN TAZEWELL RESCUE SQUAD
Entity Type:Organization
Organization Name:NORTHERN TAZEWELL RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSEWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-698-4700
Mailing Address - Street 1:2445 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-1761
Mailing Address - Country:US
Mailing Address - Phone:309-698-4700
Mailing Address - Fax:309-698-7885
Practice Address - Street 1:2445 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-1761
Practice Address - Country:US
Practice Address - Phone:309-698-4700
Practice Address - Fax:309-698-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225823416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09032026OtherBCBS
IL09032026OtherBCBS
IL09032026OtherBCBS