1174561591 NPI number — VILLAGE OF BUFFALO GROVE

Table of content: (NPI 1174561591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174561591 NPI number — VILLAGE OF BUFFALO GROVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF BUFFALO GROVE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BUFFALO GROVE FIRE DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174561591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
395 W LAKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60126-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-903-2381
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1051 HIGHLAND GROVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60089-7026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-537-0995
Provider Business Practice Location Address Fax Number:
847-537-7370
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
847-777-6100

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  98179 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07125772 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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