Provider Demographics
NPI:1134134844
Name:VILLAGE OF LANSING
Entity Type:Organization
Organization Name:VILLAGE OF LANSING
Other - Org Name:LANSING POLICE AND FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGOROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-895-7202
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-0146
Mailing Address - Country:US
Mailing Address - Phone:708-895-7202
Mailing Address - Fax:708-895-6878
Practice Address - Street 1:19300 BURNHAM AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3824
Practice Address - Country:US
Practice Address - Phone:708-895-7202
Practice Address - Fax:708-895-6878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL89033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1621018OtherBCBS
IL1621018OtherBCBS
IL=========001Medicaid
IL=========OtherTRICARE NORTH
IL590008166Medicare PIN