1730243569 NPI number — CITY OF BLUE ISLAND

Table of content: (NPI 1730243569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730243569 NPI number — CITY OF BLUE ISLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF BLUE ISLAND
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:
6
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:
1730243569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1053
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOKENA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60448-2052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-478-5694
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 VERMONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60406-2362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-233-1170
Provider Business Practice Location Address Fax Number:
773-233-8146
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYWOOD
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
708-606-6736

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  815701 , 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: 1636216 . This is a "BC BS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 132857300 . This is a "U.S. DEPT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: L027264 . This is a "CHAMPUS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1636216 . This is a "HMO ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com