# COUNTRYSIDE FIRE PROTECTION DIST

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

## Provider details

- **NPI number:** 1407872831
- **Authorized official:** CHARLES SMITH (FIRE CHIEF)
- **Authorized official phone:** (847) 367-5511

## Contact information

- **Practice address:** 600 N DEERPATH DR, VERNON HILLS, IL 60061-1804
- **Practice address phone:** (847) 367-5511
- **Practice address fax:** (847) 367-5521
- **Mailing address:** PO BOX 1368, ELMHURST, IL 60126-8368
- **Mailing address phone:** (630) 530-2988
- **Mailing address fax:** (630) 832-9750

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 7273 | IL | Yes |

## Other

- **Enumeration date:** 07/15/2006
- **Last updated:** 09/05/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 132911900 | DOL OWCP | IL |
| 01 | — | 4971120 | BCBS | IL |
| 01 | — | 590013813 | RR MEDICARE | IL |