MEDICARE: LONG GROVE 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	107266	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590013830	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	049-90002	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1689680894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG GROVE FIRE PROTECTION DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 6253
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60197-6253
Country	:	US
Telephone Number	:	630-530-2988
Fax Number	:	630-832-9750

Provider Business Practice Location Address
First Line	:	1165 OLD MCHENRY RD
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047-5088
Country	:	US
Telephone Number	:	847-634-3143
Fax Number	:	847-634-2027

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	PAUL SEGALLA
Credential	:
Telephone Number	:	847-634-3143

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	09/08/2025

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Directions to “LONG GROVE FIRE PROTECTION DISTRICT ” Practice Location

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