Provider Demographics
NPI:1245291962
Name:CISSNA PARK FIRE PROTECTION DISTRICT IROQUOIS COUNTY ILLINOIS
Entity type:Organization
Organization Name:CISSNA PARK FIRE PROTECTION DISTRICT IROQUOIS COUNTY ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/BOARD OF TRUSTEES
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:VERKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-457-2900
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:206 N SECOND STREET
Mailing Address - City:CISSNA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60924-0273
Mailing Address - Country:US
Mailing Address - Phone:815-457-2900
Mailing Address - Fax:
Practice Address - Street 1:206 N SECOND STREET
Practice Address - Street 2:
Practice Address - City:CISSNA PARK
Practice Address - State:IL
Practice Address - Zip Code:60924
Practice Address - Country:US
Practice Address - Phone:815-457-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6 6767341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL693300Medicare ID - Type UnspecifiedPART B