Provider Demographics
NPI:1891728499
Name:VILLAGE OF WHEELING
Entity Type:Organization
Organization Name:VILLAGE OF WHEELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:KIETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MACISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-459-2662
Mailing Address - Street 1:395 W LAKE ST
Mailing Address - Street 2:
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 1:2 COMMUNITY BLVD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2726
Practice Address - Country:US
Practice Address - Phone:847-459-2662
Practice Address - Fax:847-459-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1081993416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590015645OtherRAILROAD MEDICARE
IL016-32918OtherBCBS
IL590015645OtherRAILROAD MEDICARE
IL=========001Medicaid