# BRAIDWOOD VOLUNTEER FIRE DEPARTMENT

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

## Provider details

- **NPI number:** 1801801782
- **Authorized official:** KEN HEBERER (FIRE CHIEF)
- **Authorized official phone:** (815) 458-2000

## Contact information

- **Practice address:** 275 W MAIN ST, BRAIDWOOD, IL 60408-1919
- **Practice address phone:** (815) 458-2000
- **Practice address fax:** (815) 458-3636
- **Mailing address:** 395 WEST LAKE STREET, ATTN: KIMBERLY FULLER, ELMHURST, IL 60126-1508
- **Mailing address phone:** (630) 903-2372
- **Mailing address fax:** (630) 903-2830

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 77151 | IL | Yes |

## Other

- **Enumeration date:** 07/29/2006
- **Last updated:** 02/16/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 099-32200 | BCBS | IL |
| 01 | — | P00166596 | RAILROAD MEDICARE | IL |