Provider Demographics
NPI:1639174006
Name:VILLAGE OF LINCOLNWOOD
Entity Type:Organization
Organization Name:VILLAGE OF LINCOLNWOOD
Other - Org Name:LINCOLNWOOD FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE DEPARTMENT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-673-1545
Mailing Address - Street 1:6900 N. LINCOLN AVE.
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712
Mailing Address - Country:US
Mailing Address - Phone:847-673-1545
Mailing Address - Fax:847-673-7456
Practice Address - Street 1:6900 N. LINCOLN
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712
Practice Address - Country:US
Practice Address - Phone:847-673-1545
Practice Address - Fax:847-673-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01671477OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL955550Medicare ID - Type Unspecified
IL01671477OtherBLUE CROSS BLUE SHIELD