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NPI Code Detail

MEDICARE: VILLAGE OF PARK FOREST

MEDICARE: VILLAGE OF PARK FOREST
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
13416L0300XLand Ambulance8162IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2590006813OTHERILRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11670780OTHERILBCBS

General Provider Information

NPI Number : 1902846215
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLAGE OF PARK FOREST
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 : 156 INDIANWOOD BLVD
Second Line :
City : PARK FOREST
State : IL
Zip : 60466-2044
Country : US
Telephone Number : 708-748-5605
Fax Number : 708-748-4890
Authorized Official
Title or Position : FIRE CHIEF
Name : ROBERT WILCOX
Credential :
Telephone Number : 708-748-5605
Provider Enumeration Date : 06/07/2006
Last Update Date : 06/26/2008

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Directions to “VILLAGE OF PARK FOREST ” Practice Location

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