Provider Demographics
NPI:1750431979
Name:GEORGETOWN FIRE PROTECTION DISTRICT AMBULANCE SERVICE
Entity type:Organization
Organization Name:GEORGETOWN FIRE PROTECTION DISTRICT AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-662-2701
Mailing Address - Street 1:211 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:61846-1855
Mailing Address - Country:US
Mailing Address - Phone:217-662-2701
Mailing Address - Fax:217-662-2591
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IL
Practice Address - Zip Code:61846-1855
Practice Address - Country:US
Practice Address - Phone:217-662-2701
Practice Address - Fax:217-662-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid