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Organization
BRAIDWOOD VOLUNTEER FIRE DEPARTMENT
Active
Organization
BRAIDWOOD VOLUNTEER FIRE DEPARTMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN HEBERER (FIRE CHIEF)
(815) 458-2000
Entity
Organization
Contact information
Practice address
275 W MAIN ST, BRAIDWOOD, IL 60408-1919
(815) 458-2000
(815) 458-3636
Mailing address
395 WEST LAKE STREET, ATTN: KIMBERLY FULLER, ELMHURST, IL 60126-1508
(630) 903-2372
(630) 903-2830
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
77151
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099-32200
BCBS
IL
01
—
P00166596
RAILROAD MEDICARE
IL
Enumeration date
07/29/2006
Last updated
02/16/2012
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