Provider Demographics
NPI:1205855707
Name:VILLAGE OF WILMETTE
Entity Type:Organization
Organization Name:VILLAGE OF WILMETTE
Other - Org Name:WILMETTE FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-251-2700
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-7967
Practice Address - Street 1:1304 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1664
Practice Address - Country:US
Practice Address - Phone:847-251-2700
Practice Address - Fax:847-853-7642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL82023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632895OtherBCBS
IL590015238OtherRR MEDICARE
IL611708300OtherDOL OWCP
IL590015238OtherRR MEDICARE
IL=========OtherTRICARE NORTH
IL590015238OtherRR MEDICARE
IL=========001Medicaid