Provider Demographics
NPI:1841328564
Name:ASHTON FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:ASHTON FIRE PROTECTION DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:EMS COORDINATOR NREM
Authorized Official - Phone:815-973-2906
Mailing Address - Street 1:2107 GUILES AVE
Mailing Address - Street 2:P.O. BOX 260
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-1209
Mailing Address - Country:US
Mailing Address - Phone:815-539-2468
Mailing Address - Fax:815-539-6427
Practice Address - Street 1:704 MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:IL
Practice Address - Zip Code:61006-0485
Practice Address - Country:US
Practice Address - Phone:815-453-7721
Practice Address - Fax:815-453-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1 1005 013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
ILIL4613Medicare PIN