MEDICARE: SOUTH ELGIN AND COUNTRYSIDE 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	7287	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4570002	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1568405835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH ELGIN AND COUNTRYSIDE FIRE PROTECTION DISTRICT

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	:	847-577-7967

Provider Business Practice Location Address
First Line	:	150 W STATE ST
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-1912
Country	:	US
Telephone Number	:	847-741-2141
Fax Number	:	847-741-2184

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	JOSEPH CLUCHEY
Credential	:
Telephone Number	:	847-741-2141

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	05/01/2008

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Directions to “SOUTH ELGIN AND COUNTRYSIDE FIRE PROTECTION DISTRICT ” Practice Location

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