1508183583 NPI number — THE WOMEN INSTITUTE SC

Table of content: (NPI 1508183583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508183583 NPI number — THE WOMEN INSTITUTE SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WOMEN INSTITUTE 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:
1508183583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1629 S PRAIRIE AVE
Provider Second Line Business Mailing Address:
# 1508
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60616-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-382-1224
Provider Business Mailing Address Fax Number:
773-362-1085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 N WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60618-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-382-1224
Provider Business Practice Location Address Fax Number:
773-362-1085
Provider Enumeration Date:
04/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
CLAUDIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
773-382-1224

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  036118733 , 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: 036118733 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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