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General NPI Number Information
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NPI Number | 1700198157
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Entity Type | Organization
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Legal Business Name | ESSEX VOLUNTEER FIRE DEPT
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 201 W MAIN ST
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City | ESSEX
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State | IL
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Zip | 60935-0094
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Country | US
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Telephone | 815-365-2508
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 94
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City | ESSEX
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State | IL
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Zip | 60935-0094
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Country | US
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Telephone | 815-365-2508
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Fax |
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Authorized Official
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Title or Position | FIRE CHIEF
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Name | MR. AUSTIN VININGS
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Credential |
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Telephone | 815-365-2508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 077253
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License Number State | IL
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