Provider Demographics
NPI:1649208570
Name:VILLAGE OF CAMBRIA
Entity type:Organization
Organization Name:VILLAGE OF CAMBRIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-985-6082
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:IL
Mailing Address - Zip Code:62915-0218
Mailing Address - Country:US
Mailing Address - Phone:618-985-6082
Mailing Address - Fax:618-985-8338
Practice Address - Street 1:100 SOUTH MAPLE STREET
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:IL
Practice Address - Zip Code:62915-0218
Practice Address - Country:US
Practice Address - Phone:618-985-6082
Practice Address - Fax:618-985-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL516201341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
234610Medicare ID - Type Unspecified