MEDICARE: VILLAGE OF CHICAGO RIDGE

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	817401	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1636181	OTHER	IL	HMO ILLINOIS
2	590003513	OTHER	IL	RAILROAD RETIREMENT
3	1636181	OTHER	IL	BC BS OF ILLINOIS

General Provider Information

NPI Number	:	1285798686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF CHICAGO RIDGE

Provider Business Mailing Address
First Line	:	10455 S. RIDGELAND
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-1513
Country	:	US
Telephone Number	:	708-425-7700
Fax Number	:	773-233-8146

Provider Business Practice Location Address
First Line	:	10063 VIRGINIA
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-1382
Country	:	US
Telephone Number	:	708-857-4454
Fax Number	:	773-233-8146

Authorized Official
Title or Position	:	VILLAGE CLERK
Name	:	BARBARA M HARRISON
Credential	:
Telephone Number	:	708-425-7700

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	09/05/2025

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Directions to “VILLAGE OF CHICAGO RIDGE ” Practice Location

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