MEDICARE: LITTLE ROCK FOX FIRE PROTECTION DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	097169	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590014999	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04732006	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1194747188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE ROCK FOX FIRE PROTECTION DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:
City	:	WHEELING
State	:	IL
Zip	:	60090-0457
Country	:	US
Telephone Number	:	847-577-8811
Fax Number	:	847-577-3518

Provider Business Practice Location Address
First Line	:	5 E NORTH ST
Second Line	:
City	:	PLANO
State	:	IL
Zip	:	60545-1529
Country	:	US
Telephone Number	:	630-552-3311
Fax Number	:	630-618-3800

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MR. GREGORY R WITEK
Credential	:
Telephone Number	:	630-552-3311

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	11/12/2013

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