1952552101 NPI number — BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Table of content: (NPI 1952552101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952552101 NPI number — BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
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:
UIMC REFERENCE LAB PROFESSIONAL GROUP
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:
1952552101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 S WOOD ST
Provider Second Line Business Mailing Address:
ROOM 170 (MC 750)
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-355-5800
Provider Business Mailing Address Fax Number:
312-996-8261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 S WOOD ST
Provider Second Line Business Practice Location Address:
ROOM 170 (MC 750)
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-355-5800
Provider Business Practice Location Address Fax Number:
312-996-8261
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KNORR
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
K
Authorized Official Title or Position:
VICE PRESIDENT, CHIEF FINANCIAL OFF
Authorized Official Telephone Number:
312-996-8800

Provider Taxonomy Codes

  • Taxonomy code: 207ZB0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZC0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZC0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZD0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZF0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZH0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZI0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZM0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZN0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0104X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0213X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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