Provider Demographics
NPI:1811001050
Name:PAWNEE FIRE PROTECTION DIST
Entity Type:Organization
Organization Name:PAWNEE FIRE PROTECTION DIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-625-3131
Mailing Address - Street 1:711 8TH ST
Mailing Address - Street 2:P O BOX 922
Mailing Address - City:PAWNEE
Mailing Address - State:IL
Mailing Address - Zip Code:62558-0922
Mailing Address - Country:US
Mailing Address - Phone:217-625-7018
Mailing Address - Fax:217-625-8241
Practice Address - Street 1:711 8TH ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:IL
Practice Address - Zip Code:62558-0922
Practice Address - Country:US
Practice Address - Phone:217-625-7018
Practice Address - Fax:217-625-8241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3 36373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL565960Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID