Provider Demographics
NPI:1073512240
Name:VILLAGE OF LOMBARD
Entity type:Organization
Organization Name:VILLAGE OF LOMBARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY MEDICAL SERVICES CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRIENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-620-5736
Mailing Address - Street 1:255 E WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3926
Mailing Address - Country:US
Mailing Address - Phone:630-873-4501
Mailing Address - Fax:
Practice Address - Street 1:255 E WILSON AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3926
Practice Address - Country:US
Practice Address - Phone:630-620-5736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2270151OtherBCBS OF IL
IL=========001Medicaid
663770Medicare ID - Type Unspecified
IL2270151OtherBCBS OF IL