Provider Demographics
NPI:1851332159
Name:CITY OF PARK RIDGE
Entity Type:Organization
Organization Name:CITY OF PARK RIDGE
Other - Org Name:PARK RIDGE FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:LIEUTENANT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JARKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-337-8174
Mailing Address - Street 1:505 BUTLER PLACE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4648
Mailing Address - Country:US
Mailing Address - Phone:847-318-5264
Mailing Address - Fax:
Practice Address - Street 1:505 BUTLER PLACE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4648
Practice Address - Country:US
Practice Address - Phone:847-318-5264
Practice Address - Fax:847-318-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL81943416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590007926OtherRR MEDICARE
IL1670787OtherBCBS
IL=========OtherTRICARE NORTH
IL1670787OtherBCBS
IL=========001Medicaid
IL1670787OtherBCBS