MEDICARE: MARSHALL FIRE PROTECTION DISTRICT AMBULANCE 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	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001270677	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457353211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL FIRE PROTECTION DISTRICT AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	914 ASH ST
Second Line	:
City	:	MARSHALL
State	:	IL
Zip	:	62441-1324
Country	:	US
Telephone Number	:	217-826-5847
Fax Number	:	217-826-6837

Provider Business Practice Location Address
First Line	:	914 ASH ST
Second Line	:
City	:	MARSHALL
State	:	IL
Zip	:	62441-1324
Country	:	US
Telephone Number	:	217-826-5847
Fax Number	:	217-826-6837

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. GEORGE E MACEY
Credential	:	PARAMEDIC
Telephone Number	:	217-826-5847

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	01/24/2020

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