Provider Demographics
NPI:1114271244
Name:VILLAGE OF ANTIOCH
Entity Type:Organization
Organization Name:VILLAGE OF ANTIOCH
Other - Org Name:ANTIOCH FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-395-5511
Mailing Address - Street 1:835 HOLBEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-0000
Mailing Address - Country:US
Mailing Address - Phone:847-395-5511
Mailing Address - Fax:
Practice Address - Street 1:835 HOLBEK DRIVE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-0000
Practice Address - Country:US
Practice Address - Phone:847-395-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport