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General NPI Number Information
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NPI Number | 1083764880
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Entity Type | Organization
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Legal Business Name | WALNUT FIRE DEPARTMENT INC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 115 LIBERTY STREET
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City | WALNUT
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State | IL
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Zip | 61376
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Country | US
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Telephone | 815-379-2341
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Fax | 815-379-9531
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Provider Business Mailing Address
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Address Line | 115 LIBERTY STREET P.O. BOX 277
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City | WALNUT
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State | IL
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Zip | 61376
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RESCUE CAPTAIN
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Name | MR. JONATHAN K DAVIS
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Credential |
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Telephone | 815-379-9257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 2895
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License Number State | IL
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