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General NPI Number Information
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NPI Number | 1740809870
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Entity Type | Organization
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Legal Business Name | BLACKHAWK FIRE PROTECTION DISTRICT
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 3738 S MAIN ST
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City | ROCKFORD
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State | IL
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Zip | 61102-4239
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Country | US
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Telephone | 815-962-1584
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Fax | 815-962-4275
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Provider Business Mailing Address
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Address Line | PO BOX 260
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City | MENDOTA
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State | IL
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Zip | 61342-0260
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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 | FIRE CHIEF
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Name | JONATHAN TRAIL
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Credential |
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Telephone | 815-962-1584
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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 |
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License Number State |
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