Healthcare Provider Details

I. General information

NPI: 1154337889
Provider Name (Legal Business Name): TOWN OF CICERO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 W 25TH ST
CICERO IL
60804-3311
US

IV. Provider business mailing address

5303 W 25TH ST
CICERO IL
60804-3311
US

V. Phone/Fax

Practice location:
  • Phone: 708-652-0174
  • Fax: 708-652-2150
Mailing address:
  • Phone: 708-652-0174
  • Fax: 708-652-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number87918
License Number StateIL

VIII. Authorized Official

Name: DAVID A GONZALEZ
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 708-656-3600