1841331774 NPI number — LONDON MILLS COMMUNITY FIRE PROTECTION DISTRICT

Table of content: DR. ABEL E CAMPANO DEVARONA DMD (NPI 1194566448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841331774 NPI number — LONDON MILLS COMMUNITY FIRE PROTECTION DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONDON MILLS COMMUNITY FIRE PROTECTION DISTRICT
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:
1841331774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON MILLS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61554-0301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-682-5280
Provider Business Mailing Address Fax Number:
309-486-3402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 S 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON MILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61554-0301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-682-5280
Provider Business Practice Location Address Fax Number:
309-486-3402
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD TREASURER
Authorized Official Telephone Number:
309-338-5512

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  000002514 , 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: 02932005 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00132969 . This is a "PALMETTO GBA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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