MEDICARE: DANVERS EMERGENCY & RESCUE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0002X	Emergency Care Clinic/Center	676601	IL

General Provider Information

NPI Number	:	1306017256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANVERS EMERGENCY & RESCUE SERVICE

Provider Business Mailing Address
First Line	:	208 E. MAIN ST.
Second Line	:	P. O. BOX 524
City	:	DANVERS
State	:	IL
Zip	:	61732
Country	:	US
Telephone Number	:	309-963-4048
Fax Number	:	309-963-4048

Provider Business Practice Location Address
First Line	:	208 E. MAIN ST.
Second Line	:
City	:	DANVERS
State	:	IL
Zip	:	61732-9197
Country	:	US
Telephone Number	:	309-963-4048
Fax Number	:	309-963-4048

Authorized Official
Title or Position	:	BILLING CLERK
Name	:	GAIL A LITWILLER
Credential	:
Telephone Number	:	309-963-4048

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	06/18/2008

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