1003135526 NPI number — WESTERN REHABILITATION AND PAIN MANAGEMENT, S.C.

Table of content: (NPI 1003135526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003135526 NPI number — WESTERN REHABILITATION AND PAIN MANAGEMENT, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN REHABILITATION AND PAIN MANAGEMENT, S.C.
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:
1003135526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5978
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLA PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-5312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-873-5425
Provider Business Mailing Address Fax Number:
630-620-1196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2340 S HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
LOMBARD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60148-5397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-873-5425
Provider Business Practice Location Address Fax Number:
630-620-1196
Provider Enumeration Date:
05/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SIDDIQUI
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-873-5425

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  036082891 , 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)





Copyright © 2007-2024 www.npivalidator.com