Organization
CITY OF COUNTRY CLUB HILLS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHELLE COON (FIRE CHIEF)
(708) 478-5694
Entity
Organization
Contact information
Practice address
4200 W. 183RD ST, COUNTRY CLUB HILLS, IL 60478-5311
(708) 798-8488
(708) 798-8555
Mailing address
PO BOX 1053, MOKENA, IL 60448-2052
(708) 478-5694
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
78166
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016-70820
BLUE CROSS BLUE SHIELD
IL
01
—
P00151630
RAILROAD MEDICARE
IL
Enumeration date
05/19/2006
Last updated
12/10/2019
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