Healthcare Provider Details

I. General information

NPI: 1134429483
Provider Name (Legal Business Name): DOWNS COMMUNITY FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W MAIN ST
DOWNS IL
61736-9600
US

IV. Provider business mailing address

102 W MAIN ST
DOWNS IL
61736-9600
US

V. Phone/Fax

Practice location:
  • Phone: 309-378-2021
  • Fax:
Mailing address:
  • Phone: 309-378-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS98829
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier371166094001
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name: MR. MICHAEL SCOTT BETTISCH
Title or Position: EMC COORDINATOR
Credential:
Phone: 309-378-2021