MEDICARE: MT MORRIS 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	1690178	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7190001	OTHER	IL	BCBS OF IL PROVIDER NUMBE

General Provider Information

NPI Number	:	1215057898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT MORRIS FIRE PROTECTION DISTRICT

Provider Business Mailing Address
First Line	:	15 E CENTER ST
Second Line	:
City	:	MOUNT MORRIS
State	:	IL
Zip	:	61054-1460
Country	:	US
Telephone Number	:	815-734-4322
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 E CENTER ST
Second Line	:
City	:	MOUNT MORRIS
State	:	IL
Zip	:	61054-1460
Country	:	US
Telephone Number	:	815-734-4322
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	MR. ROB HOUGH
Credential	:
Telephone Number	:	815-734-4322

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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