1851469274 NPI number — WHICHDR ENTERPRISES LTD

Table of content: (NPI 1851469274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851469274 NPI number — WHICHDR ENTERPRISES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHICHDR ENTERPRISES LTD
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:
1851469274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18600 GOLF LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZEL CREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-922-1108
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 RIDGE RD STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMEWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60430-1759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-922-1108
Provider Business Practice Location Address Fax Number:
708-922-1236
Provider Enumeration Date:
12/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FLAGG
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-922-1108

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  036092720 , 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: 21623278 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".