Healthcare Provider Details

I. General information

NPI: 1073554341
Provider Name (Legal Business Name): MINOOKA FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W MONDAMIN
MINOOKA IL
60447
US

IV. Provider business mailing address

PO BOX 736
MINOOKA IL
60447-0736
US

V. Phone/Fax

Practice location:
  • Phone: 815-467-5637
  • Fax: 847-577-7967
Mailing address:
  • Phone: 815-467-5637
  • Fax: 815-467-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number7117
License Number StateIL

VIII. Authorized Official

Name: AL YANCY
Title or Position: FIRE CHIEF
Credential:
Phone: 815-467-5637