1174686992 NPI number — VILLAGE OF LYONS

Table of content: (NPI 1174686992)

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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