=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750304226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYNNVILLE-SCOTT-WHITEROCK FIRE PROTECTION DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 02/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 W FIRST ST
-----------------------------------------------------
City | LINDENWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61049-0101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-520-8591
-----------------------------------------------------
Fax | 815-393-3608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BOX 101
-----------------------------------------------------
City | LINDENWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-393-4422
-----------------------------------------------------
Fax | 815-393-3608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | TODD M SEAWORTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-520-8591
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 100301
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------