MEDICARE: DANVERS COMMUNITY FIRE PROTECTION DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	022734	IL

General Provider Information

NPI Number	:	1023311081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANVERS COMMUNITY FIRE PROTECTION DISTRICT

Provider Business Mailing Address
First Line	:	208 E MAIN ST
Second Line	:	PO BOX 268
City	:	DANVERS
State	:	IL
Zip	:	61732-9384
Country	:	US
Telephone Number	:	309-963-4812
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 E MAIN ST
Second Line	:
City	:	DANVERS
State	:	IL
Zip	:	61732-9384
Country	:	US
Telephone Number	:	309-963-4812
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	GLEN ROSECRANS
Credential	:
Telephone Number	:	309-963-4812

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	01/04/2011

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