=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548521644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALBANY FIRE PROTECTION DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2012
-----------------------------------------------------
Last Update Date | 06/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 S CHURCH ST
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61230-9677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-887-4451
-----------------------------------------------------
Fax | 605-887-4400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 74
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61230-0074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-887-4451
-----------------------------------------------------
Fax | 309-887-4400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | SHELLY LITHERLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 309-887-4451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------