Provider Demographics
NPI:1194882555
Name:VILLAGE OF WILLOW SPRINGS
Entity type:Organization
Organization Name:VILLAGE OF WILLOW SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-839-5665
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60445-0251
Mailing Address - Country:US
Mailing Address - Phone:708-389-6689
Mailing Address - Fax:708-389-6685
Practice Address - Street 1:8259 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1267
Practice Address - Country:US
Practice Address - Phone:708-839-5665
Practice Address - Fax:708-839-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1670959OtherBCBS
IL=========001Medicaid
IL1670959OtherBCBS