Healthcare Provider Details

I. General information

NPI: 1770667172
Provider Name (Legal Business Name): DUPO FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 COLUMBIA ROAD
DUPO IL
62239-1301
US

IV. Provider business mailing address

PO BOX 9
DUPO IL
62239-0009
US

V. Phone/Fax

Practice location:
  • Phone: 800-538-8278
  • Fax: 580-628-2273
Mailing address:
  • Phone: 800-538-8278
  • Fax: 580-628-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number4858
License Number StateIL

VIII. Authorized Official

Name: KURT JOHNSON
Title or Position: FIRE CHIEF
Credential:
Phone: 800-538-8278