Healthcare Provider Details

I. General information

NPI: 1689748139
Provider Name (Legal Business Name): GARDNER VOLUNTEER FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 DEPOT STREET
GARDNER IL
60424
US

IV. Provider business mailing address

35 E WILLOW ST STE B
COAL CITY IL
60416-1869
US

V. Phone/Fax

Practice location:
  • Phone: 815-237-8806
  • Fax: 815-237-0066
Mailing address:
  • Phone: 815-634-3048
  • Fax: 815-634-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number77819
License Number StateIL

VIII. Authorized Official

Name: RANDY WILKEY
Title or Position: FIRE CHIEF
Credential:
Phone: 815-237-8806