Provider Demographics
NPI:1003849472
Name:GRANT PARK FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:GRANT PARK FIRE PROTECTION DISTRICT
Other - Org Name:GRANT PARK EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:PREHOSPITAL REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VELDHUIZEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHRN
Authorized Official - Phone:815-465-6123
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:847-577-3518
Practice Address - Street 1:107 W CURTIS ST
Practice Address - Street 2:BOX 538
Practice Address - City:GRANT PARK
Practice Address - State:IL
Practice Address - Zip Code:60940-7135
Practice Address - Country:US
Practice Address - Phone:815-465-6123
Practice Address - Fax:815-465-6537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL778223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4670621OtherBLUE CROSS BLUE SHIELD
IL611537800OtherDOL OWCP
IL8181117OtherUNITED HEALTHCARE
IL590013363OtherMEDICARE RAILROAD
IL8181117OtherUNITED HEALTHCARE
IL590013363OtherMEDICARE RAILROAD
IL611537800OtherDOL OWCP