Provider Demographics
NPI:1932132008
Name:SHABBONA COMM FIRE DISTRICT
Entity Type:Organization
Organization Name:SHABBONA COMM FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTENGHEIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-824-2115
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-0260
Mailing Address - Country:US
Mailing Address - Phone:815-539-2468
Mailing Address - Fax:815-539-6427
Practice Address - Street 1:103 E NAVAHO AVE
Practice Address - Street 2:
Practice Address - City:SHABBONA
Practice Address - State:IL
Practice Address - Zip Code:60550-5147
Practice Address - Country:US
Practice Address - Phone:815-824-2115
Practice Address - Fax:815-824-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1921562OtherBCBS
IL590012025OtherRR MEDICARE
IL1921562OtherBCBS
IL=========001Medicaid
IL=========001Medicaid
IL257260Medicare PIN