MEDICARE: HOLLYWOOD HEIGHTS FIRE DEPARTMENT

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	333300000X	Emergency Response System Companies	NONE	IL

General Provider Information

NPI Number	:	1265667224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYWOOD HEIGHTS FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:
City	:	WHEELING
State	:	IL
Zip	:	60090-0457
Country	:	US
Telephone Number	:	847-577-8811
Fax Number	:	847-577-3518

Provider Business Practice Location Address
First Line	:	1214 HOLLYWOOD HEIGHTS RD
Second Line	:
City	:	CASEYVILLE
State	:	IL
Zip	:	62232-1128
Country	:	US
Telephone Number	:	618-345-8889
Fax Number	:	618-345-7048

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	EARL MOORE
Credential	:
Telephone Number	:	618-345-8889

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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Directions to “HOLLYWOOD HEIGHTS FIRE DEPARTMENT ” Practice Location

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