Basic Information
| Provider Information | |||||||||
| NPI: | 1447269832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODSTOCK FIRE/RESCUE DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 WEST LAKE STREET | ||||||||
| Address2: | ATTN: KIMBERLY FULLER | ||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601261508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309032372 | ||||||||
| FaxNumber: | 6309032830 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 E JUDD ST | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600983419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153382621 | ||||||||
| FaxNumber: | 8153342010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | HILL | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | FIRE CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8153382621 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146L00000X | 7 149 0 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic |
ID Information
| ID | Type | State | Issuer | Description | 05620987 | 01 | IL | BCBS OF ILL | OTHER |