Provider Demographics
NPI:1386892040
Name:MANLIUS FIRE PROTECTION DISTRICT FIRE DEPARTMENT
Entity type:Organization
Organization Name:MANLIUS FIRE PROTECTION DISTRICT FIRE DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-866-6602
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-0260
Mailing Address - Country:US
Mailing Address - Phone:815-539-2468
Mailing Address - Fax:815-539-6427
Practice Address - Street 1:207 E MAPLE
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:IL
Practice Address - Zip Code:61338
Practice Address - Country:US
Practice Address - Phone:815-866-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01 2557341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL---------001Medicaid
IL---------001Medicaid