MEDICARE: VILLAGE OF LINCOLNWOOD

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	01671477	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1639174006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF LINCOLNWOOD

Provider Business Mailing Address
First Line	:	6900 N. LINCOLN AVE.
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712
Country	:	US
Telephone Number	:	847-673-1545
Fax Number	:	847-673-7456

Provider Business Practice Location Address
First Line	:	6900 N. LINCOLN
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712
Country	:	US
Telephone Number	:	847-673-1545
Fax Number	:	847-673-7456

Authorized Official
Title or Position	:	FIRE DEPARTMENT COORDINATOR
Name	:	MRS. KAREN KUTCHER
Credential	:
Telephone Number	:	847-673-1545

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/15/2008

Similar Medicare Providers

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1477558534 — THOMAS SHAO
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1730185885 — MRS. SUSAN LYNNE COOPERSMITH R.D., L.D.N
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1730186040 — AMERICAN HOME CARE EXPRESS, INC.
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Directions to “VILLAGE OF LINCOLNWOOD ” Practice Location

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