Provider Demographics
NPI:1215038286
Name:THUNDERBIRD FIRE PROTECTION TERRITORY
Entity Type:Organization
Organization Name:THUNDERBIRD FIRE PROTECTION TERRITORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:QUILLIAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:812-249-8196
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 1:104 W HEAP ST
Practice Address - Street 2:
Practice Address - City:FARMERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47850
Practice Address - Country:US
Practice Address - Phone:812-696-2151
Practice Address - Fax:812-696-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10753416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000381756OtherBCBS ANTHEM
IN231890Medicare PIN