1033310933 NPI number — JOHN C FARMER MD SC

Table of content: KATHERINE MARIE ROSE M.S., LPC (NPI 1275774796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033310933 NPI number — JOHN C FARMER MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN C FARMER MD SC
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:
1033310933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8741 S GREENWOOD AVE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60619-7061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-375-1300
Provider Business Mailing Address Fax Number:
773-375-1312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8741 S GREENWOOD AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60619-7061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-375-1300
Provider Business Practice Location Address Fax Number:
773-375-1312
Provider Enumeration Date:
05/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FARMER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
773-375-1300

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , 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)