Healthcare Provider Details

I. General information

NPI: 1114050812
Provider Name (Legal Business Name): UTICA FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 N. ROUTE 178
UTICA IL
61373
US

IV. Provider business mailing address

2945 N. ROUTE 178
UTICA IL
61373
US

V. Phone/Fax

Practice location:
  • Phone: 815-667-4113
  • Fax:
Mailing address:
  • Phone: 815-667-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number22585
License Number StateIL

VIII. Authorized Official

Name: MR. MARK BIERBOM
Title or Position: EMS DIRECTOR
Credential:
Phone: 815-667-4113