Provider Demographics
NPI:1841331774
Name:LONDON MILLS COMMUNITY FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:LONDON MILLS COMMUNITY FIRE PROTECTION DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-338-5512
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:LONDON MILLS
Mailing Address - State:IL
Mailing Address - Zip Code:61554-0301
Mailing Address - Country:US
Mailing Address - Phone:309-682-5280
Mailing Address - Fax:309-486-3402
Practice Address - Street 1:301 S 2ND STREET
Practice Address - Street 2:
Practice Address - City:LONDON MILLS
Practice Address - State:IL
Practice Address - Zip Code:61554-0301
Practice Address - Country:US
Practice Address - Phone:309-682-5280
Practice Address - Fax:309-486-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000025143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02932005OtherBCBS
ILP00132969OtherPALMETTO GBA
IL=========001Medicaid
IL273750Medicare PIN