Provider Demographics
NPI:1376677021
Name:CITY OF CARTERVILLE
Entity type:Organization
Organization Name:CITY OF CARTERVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-985-2700
Mailing Address - Street 1:103 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1358
Mailing Address - Country:US
Mailing Address - Phone:618-985-2252
Mailing Address - Fax:618-985-9282
Practice Address - Street 1:300 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1272
Practice Address - Country:US
Practice Address - Phone:618-985-6528
Practice Address - Fax:618-985-6528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1769909341600000X
IL1769910341600000X
IL1769908341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590002427OtherRAI LROAD MEDICARE
IL=========001Medicaid
IL296080Medicare ID - Type Unspecified