Healthcare Provider Details

I. General information

NPI: 1679647242
Provider Name (Legal Business Name): COAL CITY FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S DE WITT PL
COAL CITY IL
60416-1537
US

IV. Provider business mailing address

PO BOX 219 35 S DEWITT ST
COAL CITY IL
60416-0219
US

V. Phone/Fax

Practice location:
  • Phone: 815-634-4700
  • Fax:
Mailing address:
  • Phone: 815-634-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number77111
License Number StateIL

VIII. Authorized Official

Name: MR. HAROLD HOLSINGER
Title or Position: FIRE CHIEF
Credential:
Phone: 815-634-4700