Provider Demographics
NPI:1588656912
Name:VILLAGE OF MELROSE PARK
Entity Type:Organization
Organization Name:VILLAGE OF MELROSE PARK
Other - Org Name:FIRE DEPARTMENT-AMBULANCE BILLING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELTRAME
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:708-344-1315
Mailing Address - Street 1:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60161-1225
Mailing Address - Country:US
Mailing Address - Phone:708-344-5880
Mailing Address - Fax:708-344-3183
Practice Address - Street 1:3601 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-2705
Practice Address - Country:US
Practice Address - Phone:708-344-1210
Practice Address - Fax:708-344-5304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL88070341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid