Provider Demographics
NPI:1942247093
Name:BEACH PARK FIRE DEPARTMENT
Entity Type:Organization
Organization Name:BEACH PARK FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-662-2642
Mailing Address - Street 1:395 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1508
Mailing Address - Country:US
Mailing Address - Phone:630-530-1280
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:3233 N LEWIS AVE
Practice Address - Street 2:
Practice Address - City:BEACH PARK
Practice Address - State:IL
Practice Address - Zip Code:60087-2210
Practice Address - Country:US
Practice Address - Phone:847-662-2642
Practice Address - Fax:847-662-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL79743416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP0078980OtherMEDICARE RAILROAD
IL206946OtherMEDICARE, PART B
IL4932215OtherBLUE CROSS BLUE SHIELD
IL4932215OtherBLUE CROSS BLUE SHIELD
IL206946OtherMEDICARE, PART B