1891030524 NPI number — PARAMEDIC SERVICES OF ILLINOIS INC,

Table of content: (NPI 1891030524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891030524 NPI number — PARAMEDIC SERVICES OF ILLINOIS INC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAMEDIC SERVICES OF ILLINOIS INC,
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:
Provider Other Organization Name Type Code:
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:
1891030524
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9815 LAWRENCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHILLER PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60176-1125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-678-4900
Provider Business Mailing Address Fax Number:
847-678-2854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1410 E JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61727-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-570-0176
Provider Business Practice Location Address Fax Number:
217-570-0177
Provider Enumeration Date:
12/06/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FIELD
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-678-4900

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  088944 , 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: 6017601 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590003882 . This is a "R.R. MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1620086 . This is a "BLUECROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".