MEDICARE: BEACH PARK FIRE DEPARTMENT

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	7974	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P0078980	OTHER	IL	MEDICARE RAILROAD
2	206946	OTHER	IL	MEDICARE, PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	4932215	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1942247093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH PARK FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	PO BOX 1368
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-8368
Country	:	US
Telephone Number	:	630-530-2988
Fax Number	:	630-832-9750

Provider Business Practice Location Address
First Line	:	3233 N LEWIS AVE
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60087-2210
Country	:	US
Telephone Number	:	847-662-2642
Fax Number	:	847-662-2779

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	THOMAS J STAHL
Credential	:
Telephone Number	:	847-662-2642

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/05/2025

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Directions to “BEACH PARK FIRE DEPARTMENT ” Practice Location

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