Provider Demographics
NPI:1912042037
Name:STEWARDSON FIRE AND AMBULANCE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:STEWARDSON FIRE AND AMBULANCE PROTECTION DISTRICT
Other - Org Name:STEWARDSON AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGENHAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-682-5710
Mailing Address - Street 1:214 NORTH PINE
Mailing Address - Street 2:
Mailing Address - City:STEWARDSON
Mailing Address - State:IL
Mailing Address - Zip Code:62463-0145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 NORTH PINE
Practice Address - Street 2:
Practice Address - City:STEWARDSON
Practice Address - State:IL
Practice Address - Zip Code:62463-0145
Practice Address - Country:US
Practice Address - Phone:217-682-5710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
212659Medicare ID - Type Unspecified