=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538618483
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEXINGTON COMMUNITY FIRE PROTECTION DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2016
-----------------------------------------------------
Last Update Date | 02/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 S BENSON ST
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61753-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-365-8477
-----------------------------------------------------
Fax | 580-628-2267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 194
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61753-0194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-365-8477
-----------------------------------------------------
Fax | 580-628-2267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS CHIEF
-----------------------------------------------------
Name | ROBERT KELLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 309-365-8703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 022832
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------