MEDICARE: VILLAGE OF MAYWOOD

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	8068	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1671614	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1861449605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF MAYWOOD

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:
City	:	WHEELING
State	:	IL
Zip	:	60090-0457
Country	:	US
Telephone Number	:	847-577-8811
Fax Number	:	847-577-7967

Provider Business Practice Location Address
First Line	:	700 SAINT CHARLES RD
Second Line	:
City	:	MAYWOOD
State	:	IL
Zip	:	60153-1372
Country	:	US
Telephone Number	:	708-343-5595
Fax Number	:	708-681-8840

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	JOHN CADAGIN
Credential	:
Telephone Number	:	708-343-5595

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	04/20/2008

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Directions to “VILLAGE OF MAYWOOD ” Practice Location

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