1154623429 NPI number — COMPREHENSIVE EMERGENCY SOLUTIONS II SC

Table of content: (NPI 1154623429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154623429 NPI number — COMPREHENSIVE EMERGENCY SOLUTIONS II SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE EMERGENCY SOLUTIONS II SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GALESBURG EMERGENCY SOLUTIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154623429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 SW WATER ST
Provider Second Line Business Mailing Address:
SUITE #509
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61602-1571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-999-1091
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
695 N KELLOGG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALESBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61401-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-343-8131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SOWARDS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
309-343-8131

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DR4766 . This is a "RRMCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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