Organization
VILLAGE OF EVERGREEN PARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RON KLEINHAUS (FIRE CHIEF)
(708) 476-3200
Entity
Organization
Contact information
Practice address
9000 S KEDZIE AVE, EVERGREEN PARK, IL 60805-1311
(773) 233-1170
(773) 233-8146
Mailing address
PO BOX 457, WHEELING, IL 60090-0457
(847) 577-8811
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1670314
BC BS OF ILLINOIS
IL
01
—
590001810
RAILROAD RETIREMENT
IL
Enumeration date
12/26/2006
Last updated
01/19/2023
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