Provider Demographics
NPI:1316985997
Name:CITY OF SYCAMORE DEKALB COUNTY ILLINOIS
Entity type:Organization
Organization Name:CITY OF SYCAMORE DEKALB COUNTY ILLINOIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:POLAREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-895-4514
Mailing Address - Street 1:535 DEKALB AVENUE
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1719
Mailing Address - Country:US
Mailing Address - Phone:815-895-4514
Mailing Address - Fax:815-895-3376
Practice Address - Street 1:535 DEKALB AVENUE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1719
Practice Address - Country:US
Practice Address - Phone:815-895-4514
Practice Address - Fax:815-895-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL113173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
010914OtherHEALTH ALLIANCE
278738000OtherDOL OWCP
IL01922224OtherBLUE CROSS BLUE SHIELD
ILSP003869OtherTHIN
1000001928OtherROCKFORD HEALTH PLANS
590006214OtherPALMETTO
62308OtherCIGNA HEALTHCARE
IL01922224OtherBLUE CROSS BLUE SHIELD
590006214OtherPALMETTO
IL01922224OtherBLUE CROSS BLUE SHIELD
=========OtherCOMMERCIAL