Provider Demographics
NPI:1912052804
Name:VILLAGE OF OAKWOOD
Entity type:Organization
Organization Name:VILLAGE OF OAKWOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-304-5980
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61858-0031
Mailing Address - Country:US
Mailing Address - Phone:217-354-4255
Mailing Address - Fax:217-354-4901
Practice Address - Street 1:106 S. SCOTT ST.
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:IL
Practice Address - Zip Code:61858-0031
Practice Address - Country:US
Practice Address - Phone:217-354-4255
Practice Address - Fax:217-354-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL653102341600000X
IL653101341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
09270817OtherBLUE CROSS
800460OtherBLACK LUNG
IL=========001Medicaid
800460OtherBLACK LUNG
600750Medicare PIN