Organization
TOWN OF CICERO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID A GONZALEZ (FINANCE DIRECTOR)
(708) 656-3600
Entity
Organization
Contact information
Practice address
5303 W 25TH ST, CICERO, IL 60804-3311
(708) 652-0174
(708) 652-2150
Mailing address
5303 W 25TH ST, CICERO, IL 60804-3311
(708) 652-0174
(708) 652-2150
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
87918
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016-71119
BCBS
IL
Enumeration date
08/01/2006
Last updated
05/11/2023
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