MEDICARE: VILLAGE OF POSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	8582	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590004073	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1649211954	OTHER	IL	BLUE CROSS/BLUE SHIEFL

General Provider Information

NPI Number	:	1649211954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF POSEN

Provider Business Mailing Address
First Line	:	PO BOX 438495
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-8495
Country	:	US
Telephone Number	:	773-233-1170
Fax Number	:	773-233-1170

Provider Business Practice Location Address
First Line	:	2440 W WALTER ZIMNY DR
Second Line	:
City	:	POSEN
State	:	IL
Zip	:	60469-1344
Country	:	US
Telephone Number	:	708-385-3110
Fax Number	:	708-389-5293

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	KEVIN SZEWCZYK
Credential	:
Telephone Number	:	708-385-3110

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	12/19/2012

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Directions to “VILLAGE OF POSEN ” Practice Location

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