Maple Park and Countryside Fire

Primary specialty

AmbulanceTaxonomy code 341600000X

License

1 1018 Issued in IL

Legal business name

MAPLE PARK AND COUNTRYSIDE FIRE

Doing business as

Maple Park and Countryside Fire

Practice address

305 S. Countyline Road
Maple Park, IL 60151

Phone

(815) 827-3500

Fax

(815) 827-3746

NPI assigned

Aug 28, 2006

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Peterson

Title

Fire Chief

Phone

(815) 827-3500

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Maple Park and Countryside Fire Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1386752525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 260",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613420260",
            "telephone_number": "815-539-2468",
            "fax_number": "815-539-6427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 S. COUNTYLINE ROAD",
            "city": "MAPLE PARK",
            "state": "IL",
            "postal_code": "60151",
            "telephone_number": "815-827-3500",
            "fax_number": "815-827-3746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE PARK AND COUNTRYSIDE FIRE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "815-827-3500"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": "1 1018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "5032052",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05032052",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Park and Countryside Fire",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulance in Maple Park, IL
• Providers in Maple Park, IL by specialty
• Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.