1093142135 NPI number — ONCOLOGY HEMATOLOGY ASSOCIATES OF NORTHERN ILLINOIS, LTD

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 1093142135 NPI number — ONCOLOGY HEMATOLOGY ASSOCIATES OF NORTHERN ILLINOIS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONCOLOGY HEMATOLOGY ASSOCIATES OF NORTHERN ILLINOIS, LTD
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:
1093142135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 689022
Provider Second Line Business Mailing Address:
CHS/PPSI/SOPHIA ARWOOD
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37068-9022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-628-6038
Provider Business Mailing Address Fax Number:
615-628-6832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 S GREENLEAF ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
GURNEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60031-3399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-336-6111
Provider Business Practice Location Address Fax Number:
847-336-7566
Provider Enumeration Date:
10/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ARWOOD
Authorized Official First Name:
SOPHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
615-221-1400

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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