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NPI Code Detail

MEDICARE: CITY OF JOLIET

MEDICARE: CITY OF JOLIET
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
13416L0300XLand Ambulance7 7093IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
142011OTHERILAMERICAN REPUBLIC IN
260054OTHERILAETNA
30009970528OTHERILBCBS
461425OTHERILSTAMARK PHCS
58100053OTHERILUNITED HEALTH CARE

General Provider Information

NPI Number : 1760472070
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY OF JOLIET
Provider Business Mailing Address
First Line : PO BOX 457
Second Line :
City : WHEELING
State : IL
Zip : 60090-0457
Country : US
Telephone Number : 847-577-8811
Fax Number : 847-577-3518
Provider Business Practice Location Address
First Line : 101 E CLINTON ST
Second Line :
City : JOLIET
State : IL
Zip : 60432-4137
Country : US
Telephone Number : 815-724-3503
Fax Number : 815-724-3548
Authorized Official
Title or Position : CHIEF OF EMS
Name : MR. RICHARD MAROSE
Credential :
Telephone Number : 815-724-3503
Provider Enumeration Date : 10/27/2005
Last Update Date : 04/20/2008

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Directions to “CITY OF JOLIET ” Practice Location

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