=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447385257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE OF NORTHBROOK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 08/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 DUNDEE RD
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-272-2141
-----------------------------------------------------
Fax | 847-272-3294
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 DUNDEE RD
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-2704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-272-2141
-----------------------------------------------------
Fax | 847-272-3294
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN CLERK
-----------------------------------------------------
Name | MAUREEN K MORRISSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-664-4494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 8192
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 10 8192
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------