Healthcare Provider Details

I. General information

NPI: 1164146379
Provider Name (Legal Business Name): CITY OF WATSEKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N 5TH ST
WATSEKA IL
60970-1273
US

IV. Provider business mailing address

201 N 5TH ST
WATSEKA IL
60970-1273
US

V. Phone/Fax

Practice location:
  • Phone: 815-867-0200
  • Fax:
Mailing address:
  • Phone: 815-867-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEVE YANA
Title or Position: EMS COORDINATOR
Credential:
Phone: 815-867-0200