Provider Demographics
NPI:1336488055
Name:THE BOARD OF TRUSTEES OF UNIVERSITY OF ILLINOIS
Entity Type:Organization
Organization Name:THE BOARD OF TRUSTEES OF UNIVERSITY OF ILLINOIS
Other - Org Name:UIC EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:BS, NRP
Authorized Official - Phone:312-355-4367
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-8368
Mailing Address - Country:US
Mailing Address - Phone:630-530-2988
Mailing Address - Fax:630-832-9750
Practice Address - Street 1:1129 S HERMITAGE AVE
Practice Address - Street 2:ROOM 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-355-4367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11 8150341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance