Basic Information
| Provider Information | |||||||||
| NPI: | 1255501383 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARTINTON FIRE PROTECTION DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 457 | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600900457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475778811 | ||||||||
| FaxNumber: | 8475773518 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 E 2800 NORTH RD | ||||||||
| Address2: | |||||||||
| City: | MARTINTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609516011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154287446 | ||||||||
| FaxNumber: | 8154287161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2008 | ||||||||
| LastUpdateDate: | 09/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | SEABERT | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | FIRE CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8153837544 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 6785 | IL | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 03832024 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER |