Healthcare Provider Details

I. General information

NPI: 1982656369
Provider Name (Legal Business Name): CITY OF BURBANK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 W 79TH ST
BURBANK IL
60459-1189
US

IV. Provider business mailing address

PO BOX 6253
CAROL STREAM IL
60197-6253
US

V. Phone/Fax

Practice location:
  • Phone: 708-599-7766
  • Fax: 708-599-9764
Mailing address:
  • Phone: 708-599-7766
  • Fax: 708-599-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number8156
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number078156
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number078156
License Number StateIL

VIII. Authorized Official

Name: MR. DAVID E GILGENBERG
Title or Position: FIRE CHIEF
Credential:
Phone: 708-599-7766