Provider Demographics
NPI:1760472070
Name:CITY OF JOLIET
Entity Type:Organization
Organization Name:CITY OF JOLIET
Other - Org Name:JOLIET FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OF EMS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-724-3503
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:847-577-3518
Practice Address - Street 1:101 E CLINTON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-4137
Practice Address - Country:US
Practice Address - Phone:815-724-3503
Practice Address - Fax:815-724-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7 70933416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL42011OtherAMERICAN REPUBLIC IN
IL60054OtherAETNA
IL0009970528OtherBCBS
IL61425OtherSTAMARK PHCS
IL8100053OtherUNITED HEALTH CARE
IL8100053OtherUNITED HEALTH CARE
IL718600Medicare PIN