=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174565998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROSPECT HEIGHTS FIRE PROTECTION DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2006
-----------------------------------------------------
Last Update Date | 05/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 E CAMP MCDONALD RD
-----------------------------------------------------
City | PROSPECT HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60070-1505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-253-8060
-----------------------------------------------------
Fax | 847-253-4759
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 457
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60090-0457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-577-8811
-----------------------------------------------------
Fax | 847-577-7967
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | SMITH DREW JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-253-8060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 8195
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------