Provider Demographics
NPI:1942330386
Name:VILLAGE OF GREENUP
Entity type:Organization
Organization Name:VILLAGE OF GREENUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VILLAGE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-923-3401
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:115 E CUMBERLAND STREET
Mailing Address - City:GREENUP
Mailing Address - State:IL
Mailing Address - Zip Code:62428-0246
Mailing Address - Country:US
Mailing Address - Phone:217-923-3401
Mailing Address - Fax:217-923-3424
Practice Address - Street 1:115E CUMBERLAND STREET
Practice Address - Street 2:
Practice Address - City:GREEENUP
Practice Address - State:IL
Practice Address - Zip Code:62428-0246
Practice Address - Country:US
Practice Address - Phone:217-923-3401
Practice Address - Fax:217-923-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL667653416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01821622OtherBLUE CROSS BLUE SHIELD
IL=========0001Medicaid
IL684450Medicare ID - Type Unspecified