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General NPI Number Information
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NPI Number | 1265455638
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Entity Type | Organization
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Legal Business Name | VILLAGE OF WORTH
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 7116 W 111TH ST
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City | WORTH
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State | IL
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Zip | 60482
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Country | US
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Telephone | 708-923-7525
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Fax |
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Provider Business Mailing Address
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Address Line | 7116 W 111TH ST
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City | WORTH
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State | IL
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Zip | 60482
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Country | US
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Telephone | 708-923-7525
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Fax |
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Authorized Official
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Title or Position | CHIEF
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Name | MR. GARY SWIERCZ
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Credential |
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Telephone | 708-923-7525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 891902
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 891901
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License Number State | IL
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