Provider Demographics
NPI:1730114091
Name:VILLAGE OF WINNETKA
Entity Type:Organization
Organization Name:VILLAGE OF WINNETKA
Other - Org Name:WINNETKA FIRE DEPARTMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-501-6028
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:847-577-8811
Mailing Address - Fax:847-577-7967
Practice Address - Street 1:428 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2528
Practice Address - Country:US
Practice Address - Phone:847-501-6029
Practice Address - Fax:847-446-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL82033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590008158OtherRR MEDICARE
IL278740800OtherDOL OWCP
IL1671464OtherBCBS
IL1671464OtherBCBS
IL278740800OtherDOL OWCP
IL=========OtherTRICARE NORTH
IL=========001Medicaid