Provider Demographics
NPI:1770540049
Name:ANTIOCH RESCUE SQUAD
Entity type:Organization
Organization Name:ANTIOCH RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESCUE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-395-1010
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-3518
Practice Address - Street 1:835 HOLBECK DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1270
Practice Address - Country:US
Practice Address - Phone:847-395-0302
Practice Address - Fax:630-903-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL872643416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL049-21246OtherBCBS OF IL
IL590012429OtherRAILROAD MEDICARE
IL=========001OtherPUBLIC AID
IL049-21246OtherBCBS OF IL