Provider Demographics
NPI:1710977103
Name:VILLAGE OF ILION
Entity Type:Organization
Organization Name:VILLAGE OF ILION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VILLAGE TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARIJO
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-895-7449
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:49 MORGAN ST.
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-1714
Practice Address - Country:US
Practice Address - Phone:315-894-6048
Practice Address - Fax:315-895-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31100341600000X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01505320Medicaid
NY590009796OtherRAILROAD MEDICARE
NY01505320Medicaid
NY01505320Medicaid