Healthcare Provider Details

I. General information

NPI: 1659527547
Provider Name (Legal Business Name): LANARK FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W. CARROLL
LANARK IL
61046
US

IV. Provider business mailing address

PO BOX 260
MENDOTA IL
61342-0260
US

V. Phone/Fax

Practice location:
  • Phone: 815-493-2431
  • Fax: 815-493-2330
Mailing address:
  • Phone: 815-539-2468
  • Fax: 815-539-6427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number01 1029
License Number StateIL

VIII. Authorized Official

Name: CONNIE KNUTTI
Title or Position: DISTRICT PRESIDENT
Credential:
Phone: 815-493-2695