Provider Demographics
NPI:1194755371
Name:MCNABB FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:MCNABB FIRE PROTECTION DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-882-2635
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:MC NABB
Mailing Address - State:IL
Mailing Address - Zip Code:61335-0219
Mailing Address - Country:US
Mailing Address - Phone:815-882-2635
Mailing Address - Fax:815-882-2035
Practice Address - Street 1:391 IL HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:MC NABB
Practice Address - State:IL
Practice Address - Zip Code:61335-5107
Practice Address - Country:US
Practice Address - Phone:815-882-2635
Practice Address - Fax:815-882-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225353416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07832001OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL206944Medicare ID - Type Unspecified