Provider Demographics
NPI:1043269038
Name:VILLAGE OF WEST DUNDEE
Entity Type:Organization
Organization Name:VILLAGE OF WEST DUNDEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-551-3805
Mailing Address - Street 1:395 WEST LAKE STREET
Mailing Address - Street 2:ATTN: KIMBERLY FULLER
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1508
Mailing Address - Country:US
Mailing Address - Phone:630-903-2372
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:100 CARRINGTON DR
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1770
Practice Address - Country:US
Practice Address - Phone:847-551-3805
Practice Address - Fax:847-551-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL971343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL045-23817OtherBLUE CROSS BLUE SHIELD
IL590010903OtherRAILROAD MEDICARE
IL=========001OtherPUBLIC AID
IL=========001OtherPUBLIC AID