Provider Demographics
NPI:1568461697
Name:VILLAGE OF HAZEL CREST
Entity Type:Organization
Organization Name:VILLAGE OF HAZEL CREST
Other - Org Name:HAZEL CREST FIRE DEPT.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VILLAGE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-335-9600
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:800-244-2345
Mailing Address - Fax:800-329-5274
Practice Address - Street 1:2903 W. 175TH STREET
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429
Practice Address - Country:US
Practice Address - Phone:708-335-9630
Practice Address - Fax:708-335-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X, 3416L0300X
IL856702146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1671559OtherBCBS OF IL
IL791590871OtherRAILROAD MEDICARE
IL=========001Medicaid
IL1671559OtherBCBS OF IL