1023217015 NPI number — STOKES INSTITUTE OF UROLOGY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023217015 NPI number — STOKES INSTITUTE OF UROLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOKES INSTITUTE OF UROLOGY, LLC
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:
1023217015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 W JACKSON ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62901-1474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-351-9300
Provider Business Mailing Address Fax Number:
618-351-9307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 W JACKSON ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62901-1474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-351-9300
Provider Business Practice Location Address Fax Number:
618-351-9307
Provider Enumeration Date:
07/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOKES
Authorized Official First Name:
SAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
618-351-9300

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  036089297 , 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: 03932016 . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00070868 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036089297 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA7587 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00152699 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: G80608 . This is a "UPIN #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 632586 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 090870 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: R78376 . This is a "UPIN #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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