# PINGREE GROVE & C SIDE FPD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003914540
- **Authorized official:** KIERAN STOUT (FIRE CHIEF)
- **Authorized official phone:** (847) 741-3151

## Contact information

- **Practice address:** 39W160 PLANK RD, ELGIN, IL 60123-8002
- **Practice address phone:** (847) 436-5335
- **Practice address fax:** (847) 436-6420
- **Mailing address:** PO BOX 6253, CAROL STREAM, IL 60197-6253
- **Mailing address phone:** (630) 530-2988
- **Mailing address fax:** (630) 832-9750

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 97907 | IL | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 09/08/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 04523024 | BCBS | IL |