Organization
CITY OF CALUMET CITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN BACHERT (CHIEF)
(708) 891-8145
Entity
Organization
Contact information
Practice address
684 WENTWORTH AVE, CALUMET CITY, IL 60409-4241
(708) 891-8145
(708) 891-3241
Mailing address
PO BOX 1053, MOKENA, IL 60448-2052
(708) 478-5694
(708) 478-5879
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
78164
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1671109
BLUE CROSS BLUE SHIELD
IL
01
—
2237310
HARMONY WELLCARE
IL
01
—
590005386
MEDICARE RAILROAD
IL
Enumeration date
06/04/2006
Last updated
12/06/2019
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