Healthcare Provider Details

I. General information

NPI: 1669535019
Provider Name (Legal Business Name): VILLAGE OF NEW BADEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E HANOVER ST
NEW BADEN IL
62265-1807
US

IV. Provider business mailing address

1 EAST HANOVER STREET
NEW BADEN IL
62265-1807
US

V. Phone/Fax

Practice location:
  • Phone: 618-588-7272
  • Fax:
Mailing address:
  • Phone: 618-588-3813
  • Fax: 618-588-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number44784
License Number StateIL

VIII. Authorized Official

Name: TIMOTHY J HOERCHLER
Title or Position: VILLAGE PRESIDENT
Credential:
Phone: 618-588-3813