Healthcare Provider Details

I. General information

NPI: 1801820873
Provider Name (Legal Business Name): WAUCONDA FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W LIBERTY ST
WAUCONDA IL
60084-2453
US

IV. Provider business mailing address

PO BOX 457
WHEELING IL
60090-0457
US

V. Phone/Fax

Practice location:
  • Phone: 847-526-2821
  • Fax: 847-526-2836
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 Number7262
License Number StateIL

VIII. Authorized Official

Name: DAVE DATO
Title or Position: FIRE CHIEF
Credential:
Phone: 847-526-2821