1831244144 NPI number — FULTON COUNTY EMERGENCY MEDICAL ASSOCIATION, INC.

Table of content: (NPI 1831244144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831244144 NPI number — FULTON COUNTY EMERGENCY MEDICAL ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FULTON COUNTY EMERGENCY MEDICAL ASSOCIATION, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1831244144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250
Provider Second Line Business Mailing Address:
635 S MAIN ST
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61520-0250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-647-5147
Provider Business Mailing Address Fax Number:
309-647-6521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
635 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61520-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-647-5147
Provider Business Practice Location Address Fax Number:
309-647-6521
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THORNTON
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
F
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
309-647-5147

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  2512 , 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)





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