| Organization Name: | MEDIC 1 |
| NPI Number: | 1134469752 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY DIETZE (DIRECTOR OF PATIENT ACCOUNTS) |
| Mailing Address: | 9850 W 190th St Suite A Mokena |
| State: | IL US |
| Postal Code: | 604485604 |
| Phone Number: | 7086701221 |
| Fax Number: | 7084781628 |
| NPI Enumeration Date: | 02/19/2013 |
| NPI Last Update Date: | 02/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | APPLIED FOR |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |