Provider Demographics
NPI:1497819684
Name:CITY OF DESPLAINES
Entity Type:Organization
Organization Name:CITY OF DESPLAINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-233-1170
Mailing Address - Street 1:PO BOX 438495
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-8495
Mailing Address - Country:US
Mailing Address - Phone:773-233-1170
Mailing Address - Fax:773-233-8146
Practice Address - Street 1:405 S RIVER RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4730
Practice Address - Country:US
Practice Address - Phone:773-233-1170
Practice Address - Fax:773-233-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL818001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL132862900OtherU S DEPT OF LABOR
IL1636185OtherHMO ILLINOIS
IL1636185OtherBC BS OF ILLINOIS
IL132862900OtherU S DEPT OF LABOR
IL365230Medicare PIN
IL1636185OtherHMO ILLINOIS