MEDICARE: VILLAGE OF WILLOW SPRINGS

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	341600000X	Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1670959	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1194882555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF WILLOW SPRINGS

Provider Business Mailing Address
First Line	:	PO BOX 251
Second Line	:
City	:	CRESTWOOD
State	:	IL
Zip	:	60445-0251
Country	:	US
Telephone Number	:	708-389-6689
Fax Number	:	708-389-6685

Provider Business Practice Location Address
First Line	:	8259 WILLOW SPRINGS RD
Second Line	:
City	:	WILLOW SPRINGS
State	:	IL
Zip	:	60480-1267
Country	:	US
Telephone Number	:	708-839-5665
Fax Number	:	708-839-9767

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MR. LARRY MORAN
Credential	:
Telephone Number	:	708-839-5665

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/19/2009

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Directions to “VILLAGE OF WILLOW SPRINGS ” Practice Location

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