1932330586 NPI number — BAYVIEW FAMILY CLINIC LTD

Table of content: (NPI 1932330586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932330586 NPI number — BAYVIEW FAMILY CLINIC LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYVIEW FAMILY CLINIC 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:
1932330586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 BURWASH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVOY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61874-9510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-356-3400
Provider Business Mailing Address Fax Number:
217-866-0122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 BURWASH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVOY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61874-9510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-356-3400
Provider Business Practice Location Address Fax Number:
217-866-0122
Provider Enumeration Date:
07/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EKUNSANMI
Authorized Official First Name:
BAMIDELE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
217-356-3400

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1932330586 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".