1083626311 NPI number — OAKSIDE CORPORATION

Table of content: (NPI 1083626311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083626311 NPI number — OAKSIDE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKSIDE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RIVERSIDE HEALTH EQUIPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083626311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 MEADOWVIEW CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANKAKEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60901-2041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-933-5187
Provider Business Mailing Address Fax Number:
815-935-7486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 MEADOWVIEW CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANKAKEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60901-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-933-5187
Provider Business Practice Location Address Fax Number:
815-935-7486
Provider Enumeration Date:
08/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CALDWELL
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF RETAIL
Authorized Official Telephone Number:
815-933-1671

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4670322 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".