Provider Demographics
NPI:1134293715
Name:PROPHETSTOWN FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:PROPHETSTOWN FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-537-2215
Mailing Address - Street 1:104 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PROPHETSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:61277-1121
Mailing Address - Country:US
Mailing Address - Phone:815-537-2215
Mailing Address - Fax:815-537-2215
Practice Address - Street 1:104 W 2ND ST
Practice Address - Street 2:
Practice Address - City:PROPHETSTOWN
Practice Address - State:IL
Practice Address - Zip Code:61277-1121
Practice Address - Country:US
Practice Address - Phone:815-537-2215
Practice Address - Fax:815-537-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11315341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL59012887OtherRAILROAD MEDICARE
IL9832010OtherBLUE CROSS BLUE SHIELD
IL9832010OtherBLUE CROSS BLUE SHIELD
IL209730Medicare ID - Type Unspecified