Provider Demographics
NPI:1992820385
Name:CITY OF EAST CHICAGO
Entity type:Organization
Organization Name:CITY OF EAST CHICAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DVORSCAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-391-8472
Mailing Address - Street 1:3901 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-2555
Mailing Address - Country:US
Mailing Address - Phone:219-391-8472
Mailing Address - Fax:219-391-8274
Practice Address - Street 1:4525 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3226
Practice Address - Country:US
Practice Address - Phone:219-391-8472
Practice Address - Fax:219-391-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0229341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN988460Medicare PIN