Basic Information
| Provider Information | |||||||||
| NPI: | 1942397013 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VILLAGE OF SKOKIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6275 | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601976275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084785694 | ||||||||
| FaxNumber: | 7084785879 | ||||||||
| Practice Location | |||||||||
| Address1: | 5127 OAKTON ST | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479825320 | ||||||||
| FaxNumber: | 8476752318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2006 | ||||||||
| LastUpdateDate: | 05/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | CZERWINSKI | ||||||||
| AuthorizedOfficialFirstName: | RALPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FIRE CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8479825320 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 108198 | IL | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 590014282 | 01 | IL | RAILROAD MEDICARE | OTHER | 01620631 | 01 | IL | BCBS | OTHER |