1588815401 NPI number — THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Table of content: (NPI 1588815401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588815401 NPI number — THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF 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:
UIC NURSING FACULTY PRACTICE AND PARTNERSHIPS
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:
1588815401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
845 S DAMEN AVE
Provider Second Line Business Mailing Address:
M/C 802 ROOM 920
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612-3727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-413-9854
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3656 N HALSTED ST
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:
60613-5974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-726-4697
Provider Business Practice Location Address Fax Number:
312-413-2588
Provider Enumeration Date:
10/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KNORR
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
COMPTROLLER
Authorized Official Telephone Number:
312-996-8800

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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