Provider Demographics
NPI:1770508004
Name:SUGAR GROVE FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:SUGAR GROVE FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-466-4513
Mailing Address - Street 1:25 MUNICIPAL DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-6900
Mailing Address - Country:US
Mailing Address - Phone:630-466-4513
Mailing Address - Fax:630-466-0911
Practice Address - Street 1:25 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-6900
Practice Address - Country:US
Practice Address - Phone:630-466-4513
Practice Address - Fax:630-466-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL78153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4521007OtherBCBS
IL590011368OtherRR MEDICARE
IL=========001Medicaid
IL590011368OtherRR MEDICARE
IL590011368Medicare PIN
IL375140Medicare PIN