MEDICARE: CITY OF COLLINSVILLE

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	341600000X	Ambulance	4857	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0006090001	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1497753875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF COLLINSVILLE

Provider Business Mailing Address
First Line	:	PO BOX 392907
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251
Country	:	US
Telephone Number	:	800-962-1484
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 S CLINTON ST
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-2726
Country	:	US
Telephone Number	:	618-346-5022
Fax Number	:	618-346-5226

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	JOHN BAILOT
Credential	:
Telephone Number	:	618-346-5022

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	05/21/2024

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Directions to “CITY OF COLLINSVILLE ” Practice Location

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