Organization
VILLAGE OF BROADVIEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW J MARTIN (DEPUTY CHIEF)
(708) 343-6124
Entity
Organization
Contact information
Practice address
2350 S 25TH AVE, BROADVIEW, IL 60155-3827
(708) 343-6124
(708) 204-8918
Mailing address
PO BOX 6253, CAROL STREAM, IL 60197-6253
(630) 530-2988
(630) 832-9750
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
88055
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016-71276
BLUE CROSS BLUE SHIELD
IL
01
—
590007932
RAILROAD MEDICARE
IL
Enumeration date
07/22/2006
Last updated
09/05/2025
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