Provider Demographics
NPI:1518007830
Name:HOMER TOWNSHIP FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:HOMER TOWNSHIP FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIEUTENANT
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESSENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-838-5006
Mailing Address - Street 1:16050 S CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8285
Mailing Address - Country:US
Mailing Address - Phone:815-838-0250
Mailing Address - Fax:815-838-6635
Practice Address - Street 1:16050 S CEDAR RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60491-8285
Practice Address - Country:US
Practice Address - Phone:815-838-0250
Practice Address - Fax:815-838-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7 71053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1518007830OtherBLUE CROSS BLUE SHIELD
IL160229513367OtherHUMANA
IL219380Medicare PIN