MEDICARE: HARMON FIRE DEPARTMENT

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	341600000X	Ambulance	01 011336	IL

General Provider Information

NPI Number	:	1326208281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARMON FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	275 STERLING RD
Second Line	:
City	:	HARMON
State	:	IL
Zip	:	61042-9703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 STERLING RD
Second Line	:
City	:	HARMON
State	:	IL
Zip	:	61042-9703
Country	:	US
Telephone Number	:	815-539-2468
Fax Number	:	815-539-6427

Authorized Official
Title or Position	:	EMS COORDINATOR
Name	:	MR. JORDAN SMITH
Credential	:
Telephone Number	:	815-677-1487

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	08/12/2009

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Directions to “HARMON FIRE DEPARTMENT ” Practice Location

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