Provider Demographics
NPI:1679514541
Name:LINCOLNSHIRE RIVERWOODS FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:LINCOLNSHIRE RIVERWOODS FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-634-2512
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-7967
Practice Address - Street 1:115 SCHELTER RD
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3603
Practice Address - Country:US
Practice Address - Phone:847-634-2512
Practice Address - Fax:847-634-2572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL79663416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590013643OtherRR MEDICARE
IL612192900OtherDEPT OF LABOR OWCP
IL4921937OtherBCBS
IL=========OtherTRICARE NORTH
IL590013643OtherRR MEDICARE
IL612192900OtherDEPT OF LABOR OWCP
IL481390Medicare PIN