MEDICARE: CITY OF EVANSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	8184	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1670032	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1174542377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF EVANSTON

Provider Business Mailing Address
First Line	:	PO BOX 4157
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-0001
Country	:	US
Telephone Number	:	847-328-2100
Fax Number	:	847-328-7311

Provider Business Practice Location Address
First Line	:	909 LAKE ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4318
Country	:	US
Telephone Number	:	847-328-2100
Fax Number	:	847-328-7311

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MICHAEL WHALEN
Credential	:
Telephone Number	:	847-328-2100

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	04/20/2008

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Directions to “CITY OF EVANSTON ” Practice Location

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