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Organization
BRACEVILLE FIRE PROTECTION DISTRICT
Active
Organization
BRACEVILLE FIRE PROTECTION DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY J. BERRY (TRUSTEE/TREASURER)
(815) 274-3653
Entity
Organization
Contact information
Practice address
102 MAIN ST.,, BRACEVILLE, IL 60407
(815) 237-8682
(815) 237-8720
Mailing address
102 MAIN ST., BOX 237, BRACEVILLE, IL 60407
(815) 237-8682
(815) 237-8720
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
77115
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03232037
BCBS
IL
05
—
364366065001
—
IL
Enumeration date
10/02/2006
Last updated
07/21/2014
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