=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194882555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE OF WILLOW SPRINGS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 08/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8259 WILLOW SPRINGS RD
-----------------------------------------------------
City | WILLOW SPRINGS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60480-1267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-839-5665
-----------------------------------------------------
Fax | 708-839-9767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 251
-----------------------------------------------------
City | CRESTWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60445-0251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-389-6689
-----------------------------------------------------
Fax | 708-389-6685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | MR. LARRY MORAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-839-5665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------