Provider Demographics
NPI:1023126299
Name:MONROE TOWNSHIP FIRE AND AMBULANCE PROTECTION DISTRICT
Entity type:Organization
Organization Name:MONROE TOWNSHIP FIRE AND AMBULANCE PROTECTION DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-539-2468
Mailing Address - Street 1:P.O. BOX 260
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-0260
Mailing Address - Country:US
Mailing Address - Phone:815-539-2468
Mailing Address - Fax:815-539-6427
Practice Address - Street 1:104 WEST STREET
Practice Address - Street 2:
Practice Address - City:MONROE CENTER
Practice Address - State:IL
Practice Address - Zip Code:61052-9804
Practice Address - Country:US
Practice Address - Phone:815-393-4222
Practice Address - Fax:815-393-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1 1351341600000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00274570OtherRAILROAD MEDICARE
IL204920Medicare ID - Type UnspecifiedTRANSPORTATION