Provider Demographics
NPI:1922014984
Name:CULLOM FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:CULLOM FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-689-2241
Mailing Address - Street 1:395 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1508
Mailing Address - Country:US
Mailing Address - Phone:630-903-2372
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:107 S. MAPLE
Practice Address - Street 2:
Practice Address - City:CULLOM
Practice Address - State:IL
Practice Address - Zip Code:60929
Practice Address - Country:US
Practice Address - Phone:815-689-2241
Practice Address - Fax:815-689-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL267253416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590011853OtherRAILROAD MEDICARE
IL05332009OtherBCBS
IL05332009OtherBCBS
IL590011853OtherRAILROAD MEDICARE