Healthcare Provider Details

I. General information

NPI: 1629014774
Provider Name (Legal Business Name): STOCKTON FIRE PROTECTION DIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E QUEEN ST
STOCKTON IL
61085-1327
US

IV. Provider business mailing address

113 E QUEEN ST
STOCKTON IL
61085-1327
US

V. Phone/Fax

Practice location:
  • Phone: 815-947-3500
  • Fax: 815-947-9102
Mailing address:
  • Phone: 815-947-3500
  • Fax: 815-947-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number100803
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number100802
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number100803
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number100802
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number100802
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number100803
License Number StateIL

VIII. Authorized Official

Name: MRS. DEBRA J HEIDENREICH
Title or Position: PRESIDENT
Credential: PHRN
Phone: 815-947-3023