1972757557 NPI number — MEAGAN M TURNER PAC

Table of content: MEAGAN M TURNER PAC (NPI 1972757557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972757557 NPI number — MEAGAN M TURNER PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TURNER
Provider First Name:
MEAGAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIBIKAWSKIS
Provider Other First Name:
MEAGAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972757557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2320 HIGH STREET
Provider Second Line Business Mailing Address:
ADMINISTRATION
Provider Business Mailing Address City Name:
BLUE ISLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60406-2426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-388-5500
Provider Business Mailing Address Fax Number:
708-388-5672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17495 LA GRANGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TINLEY PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60487-7581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-226-7000
Provider Business Practice Location Address Fax Number:
708-388-5672
Provider Enumeration Date:
11/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  085003382 , 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: P00680761 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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