Village of Merrionette Park

Primary specialty

AmbulanceTaxonomy code 341600000X

License

891001 Issued in IL

Legal business name

VILLAGE OF MERRIONETTE PARK

Practice address

11720 S Kedzie Ave
Merrionette Park, IL 60803-4516

Phone

(773) 233-1170

Fax

(773) 233-8146

NPI assigned

Dec 22, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Leonard Edling, E.M.T.

Title

Fire Chief

Phone

(773) 233-1170

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": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575936000000",
    "number": "1952466815",
    "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": "11720 S KEDZIE AVE",
            "city": "MERRIONETTE PARK",
            "state": "IL",
            "postal_code": "608034516",
            "telephone_number": "773-233-1170",
            "fax_number": "773-233-8146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF MERRIONETTE PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A",
        "authorized_official_last_name": "EDLING",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "773-233-1170",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "E.M.T."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": "891001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO ILLINOIS",
            "identifier": "1636180",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF ILLINOIS",
            "identifier": "1636180",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD RETIREMENT",
            "identifier": "590009584",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynda Gayle Swan-McClendon, LCSW
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• Sean P Tierney, M.D.
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• Thomas Chester Zimm, L.C.S.W

• Ambulance in Merrionette Park, IL
• Providers in Merrionette 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.