1760472070 NPI number — CITY OF JOLIET

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760472070 NPI number — CITY OF JOLIET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF JOLIET
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JOLIET FIRE DEPARTMENT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760472070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-577-8811
Provider Business Mailing Address Fax Number:
847-577-3518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E CLINTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60432-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-724-3503
Provider Business Practice Location Address Fax Number:
815-724-3548
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MAROSE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OF EMS
Authorized Official Telephone Number:
815-724-3503

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  7 7093 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42011 . This is a "AMERICAN REPUBLIC IN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0009970528 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 61425 . This is a "STAMARK PHCS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 8100053 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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