MEDICARE: LYNCH AREA FIRE PROTECTION DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	232750	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00305370	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0009232022	OTHER		BLUE CROSS

General Provider Information

NPI Number	:	1245334812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNCH AREA FIRE PROTECTION DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 641880
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-7880
Country	:	US
Telephone Number	:	402-572-4019
Fax Number	:	402-965-8594

Provider Business Practice Location Address
First Line	:	2315 PERRYSVILLE RD
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-9452
Country	:	US
Telephone Number	:	217-442-0153
Fax Number	:

Authorized Official
Title or Position	:	EMS COORDINATOR
Name	:	DUSTIN L HEISER
Credential	:
Telephone Number	:	217-446-9038

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	03/09/2018

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Directions to “LYNCH AREA FIRE PROTECTION DISTRICT ” Practice Location

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