Provider Demographics
NPI:1922275106
Name:CITY OF MATTOON ILLINOIS
Entity Type:Organization
Organization Name:CITY OF MATTOON ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-234-4633
Mailing Address - Street 1:1812 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-2951
Mailing Address - Country:US
Mailing Address - Phone:217-234-2442
Mailing Address - Fax:217-234-2448
Practice Address - Street 1:1812 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-2951
Practice Address - Country:US
Practice Address - Phone:217-234-2442
Practice Address - Fax:217-234-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL06 6689341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance