Provider Demographics
NPI:1770678104
Name:CITY OF NORTH CHICAGO
Entity type:Organization
Organization Name:CITY OF NORTH CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-596-8781
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:630-530-2381
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:1850 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-2050
Practice Address - Country:US
Practice Address - Phone:847-596-8780
Practice Address - Fax:847-596-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1072703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04970717OtherBCBS
IL590006106OtherRAILROAD MEDICARE
IL04970717OtherBCBS
IL240290Medicare ID - Type Unspecified