1417925546 NPI number — SHERIDAN FIRE PROTECTION DISTRICT

Table of content: (NPI 1417925546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417925546 NPI number — SHERIDAN FIRE PROTECTION DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERIDAN 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:
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:
1417925546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 260
Provider Second Line Business Mailing Address:
2107 GUILES AVENUE
Provider Business Mailing Address City Name:
MENDOTA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61342-0260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-570-2468
Provider Business Mailing Address Fax Number:
815-539-6427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 N BUSHNELL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERIDAN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60551-0508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-496-2296
Provider Business Practice Location Address Fax Number:
815-496-3401
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TIREVOLD
Authorized Official First Name:
KURTIS
Authorized Official Middle Name:
N
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
815-496-2296

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  2564 , 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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