Healthcare Provider Details

I. General information

NPI: 1841239217
Provider Name (Legal Business Name): CITY OF CALUMET CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 WENTWORTH AVE
CALUMET CITY IL
60409-4241
US

IV. Provider business mailing address

PO BOX 1053
MOKENA IL
60448-2052
US

V. Phone/Fax

Practice location:
  • Phone: 708-891-8145
  • Fax: 708-891-3241
Mailing address:
  • Phone: 708-478-5694
  • Fax: 708-478-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number78164
License Number StateIL

VIII. Authorized Official

Name: GLENN BACHERT
Title or Position: CHIEF
Credential:
Phone: 708-891-8145