Provider Demographics
NPI:1083654487
Name:CITY OF ELGIN
Entity type:Organization
Organization Name:CITY OF ELGIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FALESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-931-6100
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-7967
Practice Address - Street 1:150 DEXTER CT
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5527
Practice Address - Country:US
Practice Address - Phone:847-931-6100
Practice Address - Fax:847-931-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71293416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4590009OtherBCBS
IL=========001Medicaid
IL=========OtherTRICARE NORTH
IL302440Medicare PIN