Provider Demographics
NPI:1679604151
Name:KIRKLAND COMMUNITY FIRE DISTRICT
Entity Type:Organization
Organization Name:KIRKLAND COMMUNITY FIRE DISTRICT
Other - Org Name:KIRKLAND FIRE & RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAULL
Authorized Official - Last Name:STOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-276-4235
Mailing Address - Street 1:3891 RR # 72
Mailing Address - Street 2:BOX 657
Mailing Address - City:KIRKLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60146
Mailing Address - Country:US
Mailing Address - Phone:815-522-4414
Mailing Address - Fax:815-522-6132
Practice Address - Street 1:3891 STATE ROUTE 72
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:IL
Practice Address - Zip Code:60146-8635
Practice Address - Country:US
Practice Address - Phone:815-522-4414
Practice Address - Fax:815-522-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL110483416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01970849OtherBLUE CROSS BLUE SHIELD
IL01970849OtherBLUE CROSS/BLUE SHIELD
IL=========001Medicaid
IL01970849OtherBLUE CROSS/BLUE SHIELD