1629142138 NPI number — TAMPICO FIRE PROTECTION DISTRICT

Table of content: (NPI 1629142138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629142138 NPI number — TAMPICO FIRE PROTECTION DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMPICO 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:
1629142138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 471
Provider Second Line Business Mailing Address:
105 N MAIN ST
Provider Business Mailing Address City Name:
TAMPICO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61283-0471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-438-2082
Provider Business Mailing Address Fax Number:
815-438-2082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 N. MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPICO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-438-2082
Provider Business Practice Location Address Fax Number:
815-438-2082
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FETROW
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-COORDINATOR
Authorized Official Telephone Number:
815-438-2082

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  138302 , 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: 9832004 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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