Provider Demographics
NPI:1831291145
Name:WINNEBAGO FIRE PROTECTION DIST 1
Entity Type:Organization
Organization Name:WINNEBAGO FIRE PROTECTION DIST 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:H. DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-248-2511
Mailing Address - Street 1:115 W. HOWARD ST.
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:IL
Mailing Address - Zip Code:61024
Mailing Address - Country:US
Mailing Address - Phone:815-248-2696
Mailing Address - Fax:815-248-2458
Practice Address - Street 1:115 WEST HOWARD ST.
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:IL
Practice Address - Zip Code:61024
Practice Address - Country:US
Practice Address - Phone:815-248-2696
Practice Address - Fax:815-248-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1394341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid