Healthcare Provider Details

I. General information

NPI: 1922014984
Provider Name (Legal Business Name): CULLOM FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S. MAPLE
CULLOM IL
60929
US

IV. Provider business mailing address

395 W LAKE ST
ELMHURST IL
60126-1508
US

V. Phone/Fax

Practice location:
  • Phone: 815-689-2241
  • Fax: 815-689-2355
Mailing address:
  • Phone: 630-903-2372
  • Fax: 630-903-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number26725
License Number StateIL

VIII. Authorized Official

Name: MR. CARL KRAUSE
Title or Position: FIRE CHIEF
Credential:
Phone: 815-689-2241