Provider Demographics
NPI:1700198157
Name:ESSEX VOLUNTEER FIRE DEPT
Entity Type:Organization
Organization Name:ESSEX VOLUNTEER FIRE DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VININGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-365-2508
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:IL
Mailing Address - Zip Code:60935-0094
Mailing Address - Country:US
Mailing Address - Phone:815-365-2508
Mailing Address - Fax:
Practice Address - Street 1:201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:IL
Practice Address - Zip Code:60935-0094
Practice Address - Country:US
Practice Address - Phone:815-365-2508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL077253341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4632182OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
ILIL4728Medicare PIN