MEDICARE: CITY OF CHICAGO

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	146L00000X	Paramedic	118700	IL
2	146N00000X	Basic Emergency Medical Technician	118701	IL
3	341600000X	Ambulance	000008700	IL
4	341600000X	Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E99981874	OTHER	IL	TAX ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376554592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CHICAGO

Provider Business Mailing Address
First Line	:	33589 TREASURY CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60694-3500
Country	:	US
Telephone Number	:	312-742-7065
Fax Number	:	312-744-4792

Provider Business Practice Location Address
First Line	:	121 N. LASALLE
Second Line	:	ROOM 107A
City	:	CHICAGO
State	:	IL
Zip	:	60602-1288
Country	:	US
Telephone Number	:	312-742-7065
Fax Number	:	312-744-4792

Authorized Official
Title or Position	:	DEPUTY DIRECTOR
Name	:	MR. JOEL FLORES
Credential	:
Telephone Number	:	312-744-4002

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	02/20/2013

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Directions to “CITY OF CHICAGO ” Practice Location

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