Provider Demographics
NPI:1346313350
Name:ODELL FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:ODELL FIRE PROTECTION DISTRICT
Other - Org Name:ODELL AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-998-2410
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:210 SOUTH FRONT
Mailing Address - City:ODELL
Mailing Address - State:IL
Mailing Address - Zip Code:60460-0435
Mailing Address - Country:US
Mailing Address - Phone:815-998-2410
Mailing Address - Fax:815-998-1326
Practice Address - Street 1:210 SOUTH FRONT
Practice Address - Street 2:
Practice Address - City:ODELL
Practice Address - State:IL
Practice Address - Zip Code:60460-0435
Practice Address - Country:US
Practice Address - Phone:815-998-2410
Practice Address - Fax:815-998-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2 29883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05332021OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL705570Medicare PIN