Provider Demographics
NPI:1821003948
Name:VILLAGE OF BEDFORD PARK
Entity Type:Organization
Organization Name:VILLAGE OF BEDFORD PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MISS
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-563-4513
Mailing Address - Street 1:395 WEST LAKE STREET
Mailing Address - Street 2:ATTN: KIMBERLY FULLER
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1508
Mailing Address - Country:US
Mailing Address - Phone:630-903-2372
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:6701 S ARCHER RD
Practice Address - Street 2:
Practice Address - City:BEDFORD PARK
Practice Address - State:IL
Practice Address - Zip Code:60501-1936
Practice Address - Country:US
Practice Address - Phone:708-563-4513
Practice Address - Fax:708-563-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL789043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-32352OtherBLUE CROSS BLUE SHIELD
IL=========001OtherPUBLIC AID
IL202235Medicare ID - Type Unspecified