Provider Demographics
NPI:1497896864
Name:LOSTANT FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:LOSTANT FIRE PROTECTION DISTRICT
Other - Org Name:LOSTANT FIRE PROTECTION DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:FREITAG
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:815-712-2734
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
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 1:101 E 1ST STREET
Practice Address - Street 2:
Practice Address - City:LOSTANT
Practice Address - State:IL
Practice Address - Zip Code:61334-0024
Practice Address - Country:US
Practice Address - Phone:309-682-5280
Practice Address - Fax:309-682-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000025443416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05032042OtherBLUE CROSS BLUE SHIELD
IL05032042OtherBLUE CROSS BLUE SHIELD
IL05032042OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid