Provider Demographics
NPI:1982826665
Name:SOUTH WILMINGTON VOLUNTEER FIRE
Entity Type:Organization
Organization Name:SOUTH WILMINGTON VOLUNTEER FIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOVALCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-483-9972
Mailing Address - Street 1:P.O. BOX 285
Mailing Address - Street 2:330 LAKE STREET
Mailing Address - City:SO WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60474
Mailing Address - Country:US
Mailing Address - Phone:815-237-2244
Mailing Address - Fax:815-237-8034
Practice Address - Street 1:330 LAKE ST
Practice Address - Street 2:
Practice Address - City:SO WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60474
Practice Address - Country:US
Practice Address - Phone:815-237-2244
Practice Address - Fax:815-237-8034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7823013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport