Provider Demographics
NPI:1447390943
Name:VILLAGE OF DWIGHT
Entity Type:Organization
Organization Name:VILLAGE OF DWIGHT
Other - Org Name:DWIGHT EMERGENCY MEDICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:METZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-584-2050
Mailing Address - Street 1:209 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:DWIGHT
Mailing Address - State:IL
Mailing Address - Zip Code:60420-1323
Mailing Address - Country:US
Mailing Address - Phone:815-584-2050
Mailing Address - Fax:815-584-2848
Practice Address - Street 1:209 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:DWIGHT
Practice Address - State:IL
Practice Address - Zip Code:60420-1323
Practice Address - Country:US
Practice Address - Phone:815-584-2050
Practice Address - Fax:815-584-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL67233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL539003OtherBCBS
IL539003OtherBCBS
IL=========001Medicaid