Provider Demographics
NPI:1912085168
Name:CITY OF ST CHARLESQ
Entity type:Organization
Organization Name:CITY OF ST CHARLESQ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHELSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-377-4987
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 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1926
Practice Address - Country:US
Practice Address - Phone:630-377-4987
Practice Address - Fax:630-377-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7237341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001OtherMEDICAID
IL=========001OtherMEDICAID