1639285414 NPI number — ATS MEDICAL SERVICES, LLC

Table of content: (NPI 1639285414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639285414 NPI number — ATS MEDICAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATS MEDICAL SERVICES, LLC
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:
PRIORITY ONE
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:
1639285414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 771803
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-963-6885
Provider Business Mailing Address Fax Number:
815-639-9521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1752 WINDSOR LAKE PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LOVES PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61111-4276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-542-1111
Provider Business Practice Location Address Fax Number:
707-703-4619
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOYA
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMIN OFFICER/CHIEF COMP
Authorized Official Telephone Number:
707-992-1263

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 12521 , 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: 212092 . This is a "MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 720345 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: M300047776 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 201024140 A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com