Provider Demographics
NPI:1992053029
Name:FOUNDATION FOR EMERGENCY SERVICES
Entity type:Organization
Organization Name:FOUNDATION FOR EMERGENCY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-962-4073
Mailing Address - Street 1:PO BOX 809616
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-8802
Mailing Address - Country:US
Mailing Address - Phone:773-962-4073
Mailing Address - Fax:773-962-9276
Practice Address - Street 1:8331 S STEWART AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-1728
Practice Address - Country:US
Practice Address - Phone:773-420-1234
Practice Address - Fax:773-420-1233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST BERNARD HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-21
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002303261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care