Provider Demographics
NPI:1841239217
Name:CITY OF CALUMET CITY
Entity Type:Organization
Organization Name:CITY OF CALUMET CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-891-8145
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2052
Mailing Address - Country:US
Mailing Address - Phone:708-478-5694
Mailing Address - Fax:708-478-5879
Practice Address - Street 1:684 WENTWORTH AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-4241
Practice Address - Country:US
Practice Address - Phone:708-891-8145
Practice Address - Fax:708-891-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL781643416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590005386OtherMEDICARE RAILROAD
IL2237310OtherHARMONY WELLCARE
IL1671109OtherBLUE CROSS BLUE SHIELD
IL1671109OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL2237310OtherHARMONY WELLCARE
IL903390Medicare PIN