Mazon Verona Kinsman Rescue Squad District
Organization Active NPI Land Ambulance · Mazon, IL
NPI 1083136261 · NPPES record last updated Jul 10, 2017
Key facts
- NPI
- 1083136261
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- MAZON VERONA KINSMAN RESCUE SQUAD DISTRICT
- Practice address
- 604 Front St
Mazon, IL 60444000 - Phone
- (815) 448-2134
- Fax
- (815) 448-2302
- NPI assigned
- Jul 10, 2017
- Organization subpart
- No
Authorized official
- Name
- Jeff Marques
- Title
- Board President
- Phone
- (815) 228-2488
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171016003151 | IL | Part B Supplier - Ambulance Service Supplier | 6800162041 | Practice locations: Mazon, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
604 Front St
Mazon, IL 60444000
Mailing address
PO Box 457
Wheeling, IL 60090-0457
Phone (800) 244-2345
Other providers in Mazon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.