1942253091 NPI number — VILLAGE OF MT PROSPECT

Table of content: (NPI 1942253091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942253091 NPI number — VILLAGE OF MT PROSPECT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF MT PROSPECT
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:
1942253091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-392-6000
Provider Business Mailing Address Fax Number:
847-818-5336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 S EMERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT PROSPECT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60056-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-392-6000
Provider Business Practice Location Address Fax Number:
847-818-5336
Provider Enumeration Date:
05/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ERB
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
847-392-6000

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  8189 , 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: P00321665 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1671000 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".