1184602880 NPI number — DR. SUSAN RIFE FAMILY MEDICINE SC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184602880 NPI number — DR. SUSAN RIFE FAMILY MEDICINE SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. SUSAN RIFE FAMILY MEDICINE SC
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:
Provider Other Organization Name Type Code:
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:
1184602880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10755 W 163 PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-873-1187
Provider Business Mailing Address Fax Number:
708-873-1204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10755 W 163 PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-873-1187
Provider Business Practice Location Address Fax Number:
708-873-1204
Provider Enumeration Date:
01/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIFE
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
BARBARA
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
708-873-1187

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036077841 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036077841 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".