Provider Demographics
NPI:1760497473
Name:LIMESTONE TOWNSHIP FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:LIMESTONE TOWNSHIP FIRE PROTECTION DISTRICT
Other - Org Name:LIMESTONE FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-932-4664
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 1:4948 W STATE ROUTE 17
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-8082
Practice Address - Country:US
Practice Address - Phone:815-932-4664
Practice Address - Fax:815-932-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL72473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4630368OtherBCBS
IL590008305OtherRR MEDICARE
IL=========001Medicaid
IL=========OtherTRICARE NORTH
IL4630368OtherBCBS
IL590008305Medicare PIN