Organization
COUNTRYSIDE FIRE PROTECTION DIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES SMITH (FIRE CHIEF)
(847) 367-5511
Entity
Organization
Contact information
Practice address
600 N DEERPATH DR, VERNON HILLS, IL 60061-1804
(847) 367-5511
(847) 367-5521
Mailing address
PO BOX 1368, ELMHURST, IL 60126-8368
(630) 530-2988
(630) 832-9750
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
7273
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132911900
DOL OWCP
IL
01
—
4971120
BCBS
IL
01
—
590013813
RR MEDICARE
IL
Enumeration date
07/15/2006
Last updated
09/05/2025
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