Basic Information
| Provider Information | |||||||||
| NPI: | 1639525116 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOX LAKE FIRE PROTECTION DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 237 | ||||||||
| Address2: | |||||||||
| City: | INGLESIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600410237 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 306 WASHINGTON AVE | ||||||||
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| City: | FOX LAKE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475873312 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2016 | ||||||||
| LastUpdateDate: | 11/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | LESCHER | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | DEPUTY CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8475873312 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1174759294 | 05 | IL | MEDICAID |