Organization
ANTIOCH RESCUE SQUAD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE SOBCZAK (RESCUE CHIEF)
(847) 395-1010
Entity
Organization
Contact information
Practice address
835 HOLBECK DR, ANTIOCH, IL 60002-1270
(847) 395-0302
(630) 903-2830
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
87264
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049-21246
BCBS OF IL
IL
01
—
590012429
RAILROAD MEDICARE
IL
Enumeration date
04/28/2006
Last updated
09/19/2012
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