Provider Demographics
NPI:1841210366
Name:CITY OF EDWARDSVILLE
Entity Type:Organization
Organization Name:CITY OF EDWARDSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK/COMPTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THIEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-692-7500
Mailing Address - Street 1:118 HILLSBORO AVE
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1622
Mailing Address - Country:US
Mailing Address - Phone:618-692-7500
Mailing Address - Fax:618-692-7558
Practice Address - Street 1:118 HILLSBORO AVE
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1622
Practice Address - Country:US
Practice Address - Phone:618-692-7500
Practice Address - Fax:618-692-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4818341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL32180OtherGROUP HEALTH
IL6090016OtherBLUE CROSS/BLUE SHIELD
IL32180OtherGROUP HEALTH
IL32180OtherGROUP HEALTH