Provider Demographics
NPI:1154337889
Name:TOWN OF CICERO
Entity type:Organization
Organization Name:TOWN OF CICERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-656-3600
Mailing Address - Street 1:5303 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-3311
Mailing Address - Country:US
Mailing Address - Phone:708-652-0174
Mailing Address - Fax:708-652-2150
Practice Address - Street 1:5303 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-3311
Practice Address - Country:US
Practice Address - Phone:708-652-0174
Practice Address - Fax:708-652-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL879183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-71119OtherBCBS
IL=========001Medicaid
IL974220Medicare ID - Type Unspecified