1013955426 NPI number — BOURBONNAIS FIRE DISTRICT

Table of content: (NPI 1013955426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013955426 NPI number — BOURBONNAIS FIRE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOURBONNAIS FIRE 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:
BOURBONNAIS FIRE DEPARTMENT
Provider Other Organization Name Type Code:
5
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:
1013955426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-577-8811
Provider Business Mailing Address Fax Number:
847-577-9515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1080 ARMOUR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOURBONNAIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60914-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-935-9670
Provider Business Practice Location Address Fax Number:
815-935-9675
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ST LOUIS
Authorized Official First Name:
ED
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
815-935-9670

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  77816 , 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: 4630164 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 611645300 . This is a "DOL OWCP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 590014460 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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