Healthcare Provider Details

I. General information

NPI: 1306468871
Provider Name (Legal Business Name): GERMANTOWN FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 PRAIRIE AVE
GERMANTOWN HILLS IL
61548-9290
US

IV. Provider business mailing address

313 PRAIRIE AVE
GERMANTOWN HILLS IL
61548-9290
US

V. Phone/Fax

Practice location:
  • Phone: 309-369-1861
  • Fax:
Mailing address:
  • Phone: 309-369-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JAI W WINDISH
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 309-383-4890