Provider Demographics
NPI:1558318691
Name:MANTENO COMMUNITY FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:MANTENO COMMUNITY FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-468-6619
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:847-577-7967
Practice Address - Street 1:13 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1432
Practice Address - Country:US
Practice Address - Phone:815-468-6619
Practice Address - Fax:815-468-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL72493416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590013652OtherRR MEDICARE
IL610717000OtherDOL OWCP
MI370922463OtherBCBS MISSOURI
IL4625410OtherBCBS
IL4625410OtherBCBS
IL610717000OtherDOL OWCP
IL572570Medicare PIN
MI370922463OtherBCBS MISSOURI