Provider Demographics
NPI:1982656369
Name:CITY OF BURBANK
Entity Type:Organization
Organization Name:CITY OF BURBANK
Other - Org Name:BURBANK FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILGENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-599-7766
Mailing Address - Street 1:PO BOX 6253
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-6253
Mailing Address - Country:US
Mailing Address - Phone:708-599-7766
Mailing Address - Fax:708-599-9764
Practice Address - Street 1:6530 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1189
Practice Address - Country:US
Practice Address - Phone:708-599-7766
Practice Address - Fax:708-599-9764
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF BURBANK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-16
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL078156341600000X, 3416L0300X
IL81563416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0801234OtherAETNA HEALTH
IL36298031001Medicaid
IL0001670438OtherBLUE CROSS OF IL
IL36298031001Medicaid
IL=========OtherUNITED HEALTHCARE
IL=========001Medicaid