1174686992 NPI number — VILLAGE OF LYONS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174686992 NPI number — VILLAGE OF LYONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF LYONS
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:
Provider Other Organization Name Type Code:
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:
1174686992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 438495
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60643-8495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-233-1170
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7801 OGDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYONS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60534-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-447-8886
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NORD
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
J
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
773-233-1170

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  813101 , 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: 611564200 . This is a "DEPT. OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00161187 . This is a "RAILROAD RETIREMENT PROV." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1670397 . This is a "BC BS PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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