Organization
CITY OF EDWARDSVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATTY J THIEDE (CITY CLERK/COMPTROLLER)
(618) 692-7500
Entity
Organization
Contact information
Practice address
118 HILLSBORO AVE, EDWARDSVILLE, IL 62025-1622
(618) 692-7500
(618) 692-7558
Mailing address
118 HILLSBORO AVE, EDWARDSVILLE, IL 62025-1622
(618) 692-7500
(618) 692-7558
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
4818
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32180
GROUP HEALTH
IL
01
—
590155530
PALMETTO GBA
IL
01
—
6090016
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
07/20/2006
Last updated
04/16/2021
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