Provider Demographics
NPI:1245393073
Name:CITY OF BERWYN
Entity type:Organization
Organization Name:CITY OF BERWYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-749-6474
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-8368
Mailing Address - Country:US
Mailing Address - Phone:630-530-2988
Mailing Address - Fax:630-832-9750
Practice Address - Street 1:6700 26TH ST
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2500
Practice Address - Country:US
Practice Address - Phone:708-788-2660
Practice Address - Fax:708-788-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL805401341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000026648OtherMEDICAID PROVIDER, WISC.
IL1670585OtherBC BS PROVIDER NUMBER
IL1670585OtherHMO ILLINOIS
IL590004104OtherRAILROAD RETIREMENT #
IL=========001Medicaid
IL590004104OtherRAILROAD RETIREMENT #