Braidwood Volunteer Fire Department

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

77151 Issued in IL

Legal business name

BRAIDWOOD VOLUNTEER FIRE DEPARTMENT

Practice address

275 W Main St
Braidwood, IL 60408-1919

Phone

(815) 458-2000

Fax

(815) 458-3636

NPI assigned

Jul 29, 2006

Last updated

Feb 16, 2012By 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

Ken Heberer

Title

Fire Chief

Phone

(815) 458-2000

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1801801782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 WEST LAKE STREET",
            "address_2": "ATTN: KIMBERLY FULLER",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601261508",
            "telephone_number": "630-903-2372",
            "fax_number": "630-903-2830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 W MAIN ST",
            "city": "BRAIDWOOD",
            "state": "IL",
            "postal_code": "604081919",
            "telephone_number": "815-458-2000",
            "fax_number": "815-458-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAIDWOOD VOLUNTEER FIRE DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "HEBERER",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "815-458-2000"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "77151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00166596",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "099-32200",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mutasem Ali Ahmad
• Ak Med Equipment LLC
• Ak Medical Supplies LLC
• Align Social Services LLC
• Braidwood Fire Protection District
• Jill Chinski, LCSW
• Odalys Mary Colon Martinez, PSY.D.
• April Crawford, LMT
• Alexandria De la Rosa, MSW, LCSW
• Kathryn Devine, LMT

• Land Ambulance in Braidwood, IL
• Providers in Braidwood, IL by specialty
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.