Provider Demographics
NPI:1770648271
Name:CENTRAL STICKNEY FIRE PROTECTION
Entity Type:Organization
Organization Name:CENTRAL STICKNEY FIRE PROTECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHON
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 1:4951 S LOTUS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-1719
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:2006-12-26
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1636184OtherHMO ILLINOIS
IL1636184OtherBC BS OF ILLINOIS
IL590009208OtherRAILROAD RETIREMENT
IL=========001Medicaid
IL590009208OtherRAILROAD RETIREMENT