Village of Evergreen Park

Primary specialty

AmbulanceTaxonomy code 341600000X

Legal business name

VILLAGE OF EVERGREEN PARK

Practice address

9000 S Kedzie Ave
Evergreen Park, IL 60805-1311

Phone

(773) 233-1170

Fax

(773) 233-8146

NPI assigned

Dec 26, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ron Kleinhaus

Title

Fire Chief

Phone

(708) 476-3200

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": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1396800892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 457",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600900457",
            "telephone_number": "847-577-8811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 S KEDZIE AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608051311",
            "telephone_number": "773-233-1170",
            "fax_number": "773-233-8146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF EVERGREEN PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "KLEINHAUS",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "708-476-3200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF ILLINOIS",
            "identifier": "1670314",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD RETIREMENT",
            "identifier": "590001810",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO ILLINOIS",
            "identifier": "1670314",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Marie Vazquez, LCPC
• Kunjumol Pullathra Velayudhan, ANP
• Anna Maria Velazquez, RDN
• Rachel Vetter, FNP
• Arnulfo Vielgo, M.D.
• Dena Vincent, CRNA
• Visionworks Inc.
• Vital Care Hospice, LLC
• Vital Dental Care Inc
• Vital Healthcare Services Inc

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.