Village of Richton Park

Primary specialty

AmbulanceTaxonomy code 341600000X

License

891001 Issued in IL

Legal business name

VILLAGE OF RICHTON PARK

Practice address

4455 Sauk TRL
Richton Park, IL 60471-1126

Phone

(773) 233-1170

Fax

(773) 233-8146

NPI assigned

Dec 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Rodney Wilson, PARAMEDIC

Title

Fire Chief

Phone

(708) 478-5694

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575936000000",
    "number": "1043374481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1053",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604482052",
            "telephone_number": "708-478-5694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 SAUK TRL",
            "city": "RICHTON PARK",
            "state": "IL",
            "postal_code": "604711126",
            "telephone_number": "773-233-1170",
            "fax_number": "773-233-8146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF RICHTON PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "708-478-5694",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": "891001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS ILLINOIS",
            "identifier": "1634154",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO ILLINOIS",
            "identifier": "1634154",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD RETIREMENT",
            "identifier": "590009158",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trusted Care Inhome Services
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• Aaron Devin Vaughn, LPN
• Andrea Nicole Vaughn
• Wal-Mart Stores, Inc.
• Walgreen Co
• Angenett Wallace, RBT
• Daniel Wallace, DSW
• Walmart Inc.

• Ambulance in Richton Park, IL
• Providers in Richton Park, IL by specialty
• Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.