Provider Demographics
NPI:1588787675
Name:VILLAGE OF TILTON
Entity type:Organization
Organization Name:VILLAGE OF TILTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-PARAMEDIC
Authorized Official - Phone:217-477-0800
Mailing Address - Street 1:1001 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:IL
Mailing Address - Zip Code:61833-7100
Mailing Address - Country:US
Mailing Address - Phone:217-477-0800
Mailing Address - Fax:
Practice Address - Street 1:121 W 5TH ST
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:IL
Practice Address - Zip Code:61833-7427
Practice Address - Country:US
Practice Address - Phone:217-477-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009220616OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL0009220616OtherBLUE CROSS BLUE SHIELD