Organization
VILLAGE OF MERRIONETTE PARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEONARD EDLING E.M.T. (FIRE CHIEF)
(773) 233-1170
Entity
Organization
Contact information
Practice address
11720 S KEDZIE AVE, MERRIONETTE PARK, IL 60803-4516
(773) 233-1170
(773) 233-8146
Mailing address
PO BOX 1053, MOKENA, IL 60448-2052
(708) 478-5694
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
891001
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1636180
HMO ILLINOIS
IL
01
—
590009584
RAILROAD RETIREMENT
IL
Enumeration date
12/22/2006
Last updated
12/10/2019
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