Provider Demographics
NPI:1265462592
Name:CITY OF BREESE
Entity Type:Organization
Organization Name:CITY OF BREESE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HILMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-526-7731
Mailing Address - Street 1:500 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1624
Mailing Address - Country:US
Mailing Address - Phone:618-526-4455
Mailing Address - Fax:
Practice Address - Street 1:500 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1624
Practice Address - Country:US
Practice Address - Phone:618-526-4455
Practice Address - Fax:618-526-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
01470633OtherBLUE SHIELD
590007558OtherRR MEDICARE
590007558OtherRR MEDICARE
IL=========001Medicaid
=========001OtherCOMMERCIAL
IL=========001Medicaid