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General NPI Number Information
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NPI Number | 1295852515
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Entity Type | Organization
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Legal Business Name | CITY OF MINONK OF WOODFORD COUNTY
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 636 JEFFERSON ST
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City | MINONK
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State | IL
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Zip | 61760-1243
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Country | US
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Telephone | 309-432-2730
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Fax | 309-432-3547
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Provider Business Mailing Address
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Address Line | 670 N CHESTNUT ST
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City | MINONK
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State | IL
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Zip | 61760-1272
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Country | US
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Telephone | 309-432-2558
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Fax | 309-432-3547
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Authorized Official
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Title or Position | EMS COORDINATOR
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Name | MS. DEBORAH J STEWART
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Credential |
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Telephone | 309-432-2730
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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 | 22501
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License Number State | IL
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