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General NPI Number Information
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NPI Number | 1407872831
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Entity Type | Organization
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Legal Business Name | COUNTRYSIDE FIRE PROTECTION DIST
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 600 N DEERPATH DR
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City | VERNON HILLS
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State | IL
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Zip | 60061-1804
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Country | US
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Telephone | 847-367-5511
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Fax | 847-367-5521
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Provider Business Mailing Address
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Address Line | PO BOX 1368
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City | ELMHURST
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State | IL
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Zip | 60126-8368
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Country | US
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Telephone | 630-530-2988
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Fax | 630-832-9750
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Authorized Official
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Title or Position | FIRE CHIEF
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Name | CHARLES SMITH
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Credential |
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Telephone | 847-367-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 7273
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License Number State | IL
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