Provider Demographics
NPI:1013955426
Name:BOURBONNAIS FIRE DISTRICT
Entity Type:Organization
Organization Name:BOURBONNAIS FIRE DISTRICT
Other - Org Name:BOURBONNAIS FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:ST LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-935-9670
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:847-577-9515
Practice Address - Street 1:1080 ARMOUR RD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2102
Practice Address - Country:US
Practice Address - Phone:815-935-9670
Practice Address - Fax:815-935-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL778163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4630164OtherBLUE CROSS BLUE SHIELD
IL611645300OtherDOL OWCP
IL590014460OtherMEDICARE RAILROAD
IL4630164OtherBLUE CROSS BLUE SHIELD
IL707450Medicare PIN