Organization
CITY OF GRANITE CITY
Active
Other names
Granite City Fire Department Ambulance Service
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY JAMES CONNOLLY (FIRE CHIEF)
(618) 452-6231
Entity
Organization
Contact information
Practice address
2300 MADISON AVE, GRANITE CITY, IL 62040-4750
(618) 452-6231
(618) 452-6232
Mailing address
PO BOX 457, WHEELING, IL 60090-0457
(847) 577-8811
(847) 577-3518
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
001
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006070059
BCBS
IL
Enumeration date
01/25/2006
Last updated
07/21/2022
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