Provider Demographics
NPI:1992883953
Name:BLUEGRASS FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:BLUEGRASS FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:NIVER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:217-987-6560
Mailing Address - Street 1:P.O. BOX 260
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:IL
Mailing Address - Zip Code:61865-0260
Mailing Address - Country:US
Mailing Address - Phone:217-987-6560
Mailing Address - Fax:855-243-5633
Practice Address - Street 1:125 N LOGAN ST.
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:IL
Practice Address - Zip Code:61865-0260
Practice Address - Country:US
Practice Address - Phone:217-987-6560
Practice Address - Fax:855-243-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL006764341600000X
IL341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL37600239001Medicaid
590014094OtherRR MEDICARE
09270870OtherBLUE CROSS
590014094OtherRR MEDICARE