Provider Demographics
NPI:1255409637
Name:COYNE CENTER FIRE PROTECTION AND EMS DISTRICT
Entity type:Organization
Organization Name:COYNE CENTER FIRE PROTECTION AND EMS DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-787-2459
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-0207
Mailing Address - Country:US
Mailing Address - Phone:309-787-2459
Mailing Address - Fax:309-787-6260
Practice Address - Street 1:1624 COYNE CENTER RD
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-4044
Practice Address - Country:US
Practice Address - Phone:309-787-2459
Practice Address - Fax:309-787-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL02 29733416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363325676001Medicaid
IL363325676001Medicaid