Basic Information
| Provider Information | |||||||||
| NPI: | 1306849567 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VILLAGE OF ARLINGTON HEIGHTS A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95349 | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600950349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475778811 | ||||||||
| FaxNumber: | 8475779515 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 S ARLINGTON HEIGHTS RD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600051403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473685000 | ||||||||
| FaxNumber: | 8473685995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 12/02/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ERICKSON | ||||||||
| AuthorizedOfficialFirstName: | GLEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8473685000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CHIEF | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 98178 | IL | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 132855900 | 01 | IL | DEPT OF LABOR OWCP | OTHER | 1670140 | 01 | IL | BCBS PROVIDER NUMBER | OTHER | 792590164 | 01 | IL | MEDICARE RAILROAD | OTHER |