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General NPI Number Information
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NPI Number | 1134469752
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Entity Type | Organization
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Legal Business Name | MEDIC 1
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 9850 W 190TH ST SUITE A
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City | MOKENA
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State | IL
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Zip | 60448-5604
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Country | US
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Telephone | 708-670-1221
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Fax | 708-478-1628
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Provider Business Mailing Address
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Address Line | 9850 W 190TH ST SUITE A
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City | MOKENA
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State | IL
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Zip | 60448-5604
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Country | US
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Telephone | 708-670-1221
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Fax | 708-478-1628
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Authorized Official
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Title or Position | DIRECTOR OF PATIENT ACCOUNTS
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Name | MRS. KIMBERLY DIETZE
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Credential |
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Telephone | 708-670-1221
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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 | APPLIED FOR
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License Number State | IL
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