Healthcare Provider Details

I. General information

NPI: 1306017256
Provider Name (Legal Business Name): DANVERS EMERGENCY & RESCUE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E. MAIN ST.
DANVERS IL
61732-9197
US

IV. Provider business mailing address

208 E. MAIN ST. P. O. BOX 524
DANVERS IL
61732
US

V. Phone/Fax

Practice location:
  • Phone: 309-963-4048
  • Fax: 309-963-4048
Mailing address:
  • Phone: 309-963-4048
  • Fax: 309-963-4048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number676601
License Number StateIL

VIII. Authorized Official

Name: GAIL A LITWILLER
Title or Position: BILLING CLERK
Credential:
Phone: 309-963-4048