Provider Demographics
NPI:1770629073
Name:LITTLE MACKINAW FIRE DISTRICT
Entity Type:Organization
Organization Name:LITTLE MACKINAW FIRE DISTRICT
Other - Org Name:MINIER AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-678-5035
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:107 E CENTRAL
Mailing Address - City:MINIER
Mailing Address - State:IL
Mailing Address - Zip Code:61759-0680
Mailing Address - Country:US
Mailing Address - Phone:309-392-2112
Mailing Address - Fax:309-392-2112
Practice Address - Street 1:107 E. CENTRAL
Practice Address - Street 2:BOX 680
Practice Address - City:MINIER
Practice Address - State:IL
Practice Address - Zip Code:61759-0680
Practice Address - Country:US
Practice Address - Phone:309-392-2112
Practice Address - Fax:309-392-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport