Stockton Fire Protection Dist
Organization Active NPI Intermediate Emergency Medical Technician · Stockton, IL
NPI 1629014774 · NPPES record last updated May 11, 2011
Key facts
- NPI
- 1629014774
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intermediate Emergency Medical Technician 146M00000X
- License
- 100803 (IL)
- Legal business name
- STOCKTON FIRE PROTECTION DIST
- Practice address
- 113 E Queen St
Stockton, IL 61085-1327 - Phone
- (815) 947-3500
- Fax
- (815) 947-9102
- NPI assigned
- Jun 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Debra J Heidenreich, PHRN
- Title
- President
- Phone
- (815) 947-3023
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050407000395 | IL | Part B Supplier - Ambulance Service Supplier | 3678520046 | Practice locations: Stockton, IL |
National Provider Directory
Locations
113 E Queen Ave
Stockton, IL 61085
Phone (815) 947-3500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intermediate Emergency Medical Technician |
146M00000X | 100803 | IL | Yes |
| Intermediate Emergency Medical Technician |
146M00000X | 100802 | IL | |
| Basic Emergency Medical Technician |
146N00000X | 100803 | IL | |
| Basic Emergency Medical Technician |
146N00000X | 100802 | IL | |
| Land Ambulance | 3416L0300X | 100802 | IL | |
| Land Ambulance | 3416L0300X | 100803 | IL |
Addresses
Primary practice location
113 E Queen St
Stockton, IL 61085-1327
Mailing address
113 E Queen St
Stockton, IL 61085-1327
Phone (815) 947-3500
Other names
- Stockton Community Ambulance
Other providers in Stockton, IL
- Premier Chiropractic PC
- Caitlin M Pullara
- Travis J Ray
- Stockton Cusd 206
- Stockton Dental Center, Inc.
- Stockton Healthcare and Rehab Center Inc
- Stockton Healthcare and Rehab, Inc
- Christian G Triand
- Deedee M Wampfler
- Michael A Wampfler
All providers in Stockton, IL · Intermediate Emergency Medical Technician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2011. 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.