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Organization
VILLAGE OF BEDFORD PARK
Active
Organization
VILLAGE OF BEDFORD PARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SEAN M MALOY (FIRE CHIEF)
(708) 563-4513
Entity
Organization
Contact information
Practice address
6701 S ARCHER RD, BEDFORD PARK, IL 60501-1936
(708) 563-4513
(708) 563-0295
Mailing address
395 WEST LAKE STREET, ATTN: KIMBERLY FULLER, ELMHURST, IL 60126-1508
(630) 903-2372
(630) 903-2830
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
78904
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016-32352
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/29/2006
Last updated
02/16/2012
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