Mackinaw Fire Protection District

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

22593 Issued in IL

Legal business name

MACKINAW FIRE PROTECTION DISTRICT

Practice address

104 W Madison
Mackinaw, IL 61755

Phone

(309) 359-3571

NPI assigned

Jan 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Marion Lee Jacobs

Title

Secretary Treasurer

Phone

(309) 359-3571

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mackinaw Rescue Squad Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1295884708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W MADISON",
            "city": "MACKINAW",
            "state": "IL",
            "postal_code": "61755",
            "telephone_number": "309-359-3571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W MADISON",
            "city": "MACKINAW",
            "state": "IL",
            "postal_code": "61755",
            "telephone_number": "309-359-3571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACKINAW FIRE PROTECTION DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "MARION",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "SECRETARY TREASURER",
        "authorized_official_telephone_number": "309-359-3571",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "22593",
            "primary": true
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "2259301",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0009070901",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mackinaw Rescue Squad",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lauren Anne Cornwell
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• Tina Denny
• Dawn Irby, RPH
• Ehrica D Reaktenwalt
• Stacia D Rockhold
• Sharshon Pharmacy, Inc.
• Sharshon Pharmacy, Inc.
• Speakology, LTD

• Land Ambulance in Mackinaw, IL
• Providers in Mackinaw, IL by specialty
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.