Provider Demographics
NPI:1194747188
Name:LITTLE ROCK FOX FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:LITTLE ROCK FOX FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WITEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-552-3311
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-3518
Practice Address - Street 1:5 E NORTH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:IL
Practice Address - Zip Code:60545-1529
Practice Address - Country:US
Practice Address - Phone:630-552-3311
Practice Address - Fax:630-618-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0971693416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04732006OtherBLUE CROSS
IL590014999OtherRAILROAD MEDICARE
IL=========001Medicaid
IL04732006OtherBLUE CROSS
IL590014999OtherRAILROAD MEDICARE