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General NPI Number Information
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NPI Number | 1710055199
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Entity Type | Organization
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Legal Business Name | CITY OF KEITHSBURG
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 202 S 6TH ST
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City | KEITHSBURG
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State | IL
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Zip | 61442-5033
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Country | US
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Telephone | 309-374-2220
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Fax |
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Provider Business Mailing Address
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Address Line | 601 WASHINGTON ST
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City | KEITHSBURG
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State | IL
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Zip | 61442-9627
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Country | US
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Telephone | 309-374-2414
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | JUDITH L BROWN
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Credential |
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Telephone | 309-374-2414
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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 | 000002555
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License Number State | IL
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