Healthcare Provider Details

I. General information

NPI: 1750436002
Provider Name (Legal Business Name): VILLAGE OF WAYNE CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MILL STREET
WAYNE CITY IL
62895-0176
US

IV. Provider business mailing address

PO BOX 176
WAYNE CITY IL
62895-0176
US

V. Phone/Fax

Practice location:
  • Phone: 618-895-2241
  • Fax: 618-895-2241
Mailing address:
  • Phone: 618-895-2241
  • Fax: 618-895-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number55160
License Number StateIL

VIII. Authorized Official

Name: MRS. VICKIE L SLATER
Title or Position: VILLAGE OF WAYNE CLERK
Credential:
Phone: 618-895-2241