1003186255 NPI number — RUSH OAK PARK PHYSICIANS GROUP NORTH RIVERSIDE

Table of content: (NPI 1003186255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003186255 NPI number — RUSH OAK PARK PHYSICIANS GROUP NORTH RIVERSIDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSH OAK PARK PHYSICIANS GROUP NORTH RIVERSIDE
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:
1003186255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7222 W CERMAK RD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
NORTH RIVERSIDE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60546-1422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-660-6400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7222 W CERMAK RD
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
NORTH RIVERSIDE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60546-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-660-6400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HALPER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
312-942-7770

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , 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)