Provider Demographics
NPI:1417925546
Name:SHERIDAN FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:SHERIDAN FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:KURTIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:TIREVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:FF 2, EMT I
Authorized Official - Phone:815-496-2296
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:2107 GUILES AVENUE
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-0260
Mailing Address - Country:US
Mailing Address - Phone:866-570-2468
Mailing Address - Fax:815-539-6427
Practice Address - Street 1:405 N BUSHNELL STREET
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IL
Practice Address - Zip Code:60551-0508
Practice Address - Country:US
Practice Address - Phone:815-496-2296
Practice Address - Fax:815-496-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2564341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL319040Medicare ID - Type Unspecified