Provider Demographics
NPI:1457353211
Name:MARSHALL FIRE PROTECTION DISTRICT AMBULANCE SERVICE
Entity Type:Organization
Organization Name:MARSHALL FIRE PROTECTION DISTRICT AMBULANCE SERVICE
Other - Org Name:MFPD AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACEY
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:217-826-5847
Mailing Address - Street 1:914 ASH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-1324
Mailing Address - Country:US
Mailing Address - Phone:217-826-5847
Mailing Address - Fax:217-826-6837
Practice Address - Street 1:914 ASH ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-1324
Practice Address - Country:US
Practice Address - Phone:217-826-5847
Practice Address - Fax:217-826-6837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001270677OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL=========001Medicaid