Provider Demographics
NPI:1740220151
Name:VILLAGE OF PALATINE
Entity Type:Organization
Organization Name:VILLAGE OF PALATINE
Other - Org Name:PALATINE FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRATZIANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-202-6341
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-7967
Practice Address - Street 1:200 E WOOD ST
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-5346
Practice Address - Country:US
Practice Address - Phone:847-202-6340
Practice Address - Fax:847-202-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL82043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633594OtherBCBS
IL20513730OtherDEPT OF LABOR OWCP
ILP00077043OtherRR MEDICARE
IL=========001Medicaid
ILP00077043OtherRR MEDICARE
ILP00077043Medicare PIN
ILP00077043OtherRR MEDICARE