1770855546 NPI number — RESURRECTION SERVICES

Table of content: (NPI 1770855546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770855546 NPI number — RESURRECTION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESURRECTION SERVICES
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:
RESURRECTION MEDICAL GROUP
Provider Other Organization Name Type Code:
5
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:
1770855546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62311 COLLECTION CENTER DR
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:
60693-0623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-273-2614
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 RIDGE AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-2455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-869-1192
Provider Business Practice Location Address Fax Number:
847-869-8354
Provider Enumeration Date:
02/08/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCORMICK
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
708-583-6817

Provider Taxonomy Codes

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

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