1912195595 NPI number — BABICH SKIN CARE CENTER, INC.

Table of content: (NPI 1912195595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912195595 NPI number — BABICH SKIN CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BABICH SKIN CARE CENTER, INC.
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:
1912195595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 W HAY ST
Provider Second Line Business Mailing Address:
SUITE 313
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62526-6328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-876-6890
Provider Business Mailing Address Fax Number:
217-876-6895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 W HAY ST
Provider Second Line Business Practice Location Address:
SUITE 313
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62526-6328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-876-6890
Provider Business Practice Location Address Fax Number:
217-876-6895
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BABICH
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
217-876-6890

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  036-09961 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207NS0135X , with the licence number: 036-099961 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 007694141 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00132612 . This is a "MEDICARE R.R." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 099085 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5832043 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com