Provider Demographics
NPI:1629132048
Name:VILLAGE OF ALSIP
Entity type:Organization
Organization Name:VILLAGE OF ALSIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STYCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:708-292-0134
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:363-518-6343
Mailing Address - Fax:336-791-0196
Practice Address - Street 1:12600 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-1913
Practice Address - Country:US
Practice Address - Phone:708-292-0134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
IL815501341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216262300OtherDEPT. OF LABOR
IL590008209OtherRAILROAD RETIREMENT
IL1618132OtherBC BS OF ILLINOIS
IL1618132OtherHMO ILLINOIS
IL=========001Medicaid
IL=========001Medicaid