MEDICARE: VILLAGE OF BROADVIEW

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	3416L0300X	Land Ambulance	88055	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590007932	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	016-71276	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1730100942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF BROADVIEW

Provider Business Mailing Address
First Line	:	PO BOX 6253
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60197-6253
Country	:	US
Telephone Number	:	630-530-2988
Fax Number	:	630-832-9750

Provider Business Practice Location Address
First Line	:	2350 S 25TH AVE
Second Line	:
City	:	BROADVIEW
State	:	IL
Zip	:	60155-3827
Country	:	US
Telephone Number	:	708-343-6124
Fax Number	:	708-204-8918

Authorized Official
Title or Position	:	DEPUTY CHIEF
Name	:	MATTHEW J MARTIN
Credential	:
Telephone Number	:	708-343-6124

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	09/05/2025

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Directions to “VILLAGE OF BROADVIEW ” Practice Location

Language	Start Address	Practice Location

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