Healthcare Provider Details

I. General information

NPI: 1003849647
Provider Name (Legal Business Name): SPRING GROVE FIRE PROTECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8214 RICHARDSON RD
SPRING GROVE IL
60081-9429
US

IV. Provider business mailing address

PO BOX 457
WHEELING IL
60090-0457
US

V. Phone/Fax

Practice location:
  • Phone: 815-675-2450
  • Fax: 815-675-6284
Mailing address:
  • Phone: 847-577-8811
  • Fax: 847-577-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number7119
License Number StateIL

VIII. Authorized Official

Name: PAUL KLICKER
Title or Position: FIRE CHIEF
Credential:
Phone: 815-675-2450