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General NPI Number Information
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NPI Number | 1922014984
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Entity Type | Organization
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Legal Business Name | CULLOM FIRE PROTECTION DISTRICT
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 107 S. MAPLE
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City | CULLOM
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State | IL
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Zip | 60929
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Country | US
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Telephone | 815-689-2241
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Fax | 815-689-2355
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Provider Business Mailing Address
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Address Line | 395 W LAKE ST
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City | ELMHURST
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State | IL
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Zip | 60126-1508
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Country | US
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Telephone | 630-903-2372
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Fax | 630-903-2830
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Authorized Official
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Title or Position | FIRE CHIEF
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Name | MR. CARL KRAUSE
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Credential |
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Telephone | 815-689-2241
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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 | 26725
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License Number State | IL
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