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General NPI Number Information
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NPI Number | 1922275106
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Entity Type | Organization
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Legal Business Name | CITY OF MATTOON ILLINOIS
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 1812 PRAIRIE AVE
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City | MATTOON
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State | IL
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Zip | 61938-2951
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Country | US
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Telephone | 217-234-2442
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Fax | 217-234-2448
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Provider Business Mailing Address
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Address Line | 1812 PRAIRIE AVE
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City | MATTOON
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State | IL
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Zip | 61938-2951
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Country | US
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Telephone | 217-234-2442
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Fax | 217-234-2448
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Authorized Official
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Title or Position | MAYOR
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Name | MR. DAVID W CLINE
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Credential |
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Telephone | 217-234-4633
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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 | 06 6689
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License Number State | IL
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