1245393073 NPI number — CITY OF BERWYN

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 1245393073 NPI number — CITY OF BERWYN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BERWYN
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:
1245393073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60126-8368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-530-2988
Provider Business Mailing Address Fax Number:
630-832-9750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6700 26TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWYN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60402-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-788-2660
Provider Business Practice Location Address Fax Number:
708-788-3990
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
708-749-6474

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  805401 , 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: 000026648 . This is a "MEDICAID PROVIDER, WISC." identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1670585 . This is a "BC BS PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1670585 . This is a "HMO ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 590004104 . This is a "RAILROAD RETIREMENT #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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