Provider Demographics
NPI:1750304226
Name:LYNNVILLE-SCOTT-WHITEROCK FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:LYNNVILLE-SCOTT-WHITEROCK FIRE PROTECTION DISTRICT
Other - Org Name:LYNN SCOTT ROCK FIRE PROT DIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEAWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-520-8591
Mailing Address - Street 1:BOX 101
Mailing Address - Street 2:
Mailing Address - City:LINDENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61049
Mailing Address - Country:US
Mailing Address - Phone:815-393-4422
Mailing Address - Fax:815-393-3608
Practice Address - Street 1:106 W FIRST ST
Practice Address - Street 2:
Practice Address - City:LINDENWOOD
Practice Address - State:IL
Practice Address - Zip Code:61049-0101
Practice Address - Country:US
Practice Address - Phone:815-520-8591
Practice Address - Fax:815-393-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL100301341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
ILC45966Medicare UPIN
IL213537Medicare ID - Type Unspecified