MEDICARE: VILLAGE OF LYNWOOD

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

General Provider Information

NPI Number	:	1801589502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF LYNWOOD

Provider Business Mailing Address
First Line	:	21460 E LINCOLN HWY
Second Line	:
City	:	LYNWOOD
State	:	IL
Zip	:	60411-8742
Country	:	US
Telephone Number	:	708-758-6101
Fax Number	:

Provider Business Practice Location Address
First Line	:	21460 E LINCOLN HWY
Second Line	:
City	:	LYNWOOD
State	:	IL
Zip	:	60411-8742
Country	:	US
Telephone Number	:	708-758-6101
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MR. LASHAUN ALSTON
Credential	:
Telephone Number	:	708-510-6900

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	05/30/2023

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Directions to “VILLAGE OF LYNWOOD ” Practice Location

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