1447403852 NPI number — NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS

Table of content: (NPI 1447403852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447403852 NPI number — NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS
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:
1447403852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94644
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44101-4644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-573-5000
Provider Business Mailing Address Fax Number:
630-368-0280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 DAKOTA ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60012-3744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-301-1001
Provider Business Practice Location Address Fax Number:
815-301-1002
Provider Enumeration Date:
10/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
O'DEA
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO/COO
Authorized Official Telephone Number:
708-386-1000

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  036110997 , 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: 1548210677 . This is a "PROVIDER NPI NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com