Provider Demographics
NPI:1285798686
Name:VILLAGE OF CHICAGO RIDGE
Entity type:Organization
Organization Name:VILLAGE OF CHICAGO RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHMELZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-514-0791
Mailing Address - Street 1:10455 S. RIDGELAND
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1513
Mailing Address - Country:US
Mailing Address - Phone:708-425-7700
Mailing Address - Fax:773-233-8146
Practice Address - Street 1:10063 VIRGINIA
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1382
Practice Address - Country:US
Practice Address - Phone:708-857-4454
Practice Address - Fax:773-233-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL817401341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1636181OtherHMO ILLINOIS
IL590003513OtherRAILROAD RETIREMENT
IL1636181OtherBC BS OF ILLINOIS
IL1636181OtherBC BS OF ILLINOIS
IL=========001Medicaid