1093922064 NPI number — PEDIATRIC SUBSPECIALTY AND HOSPITALIST ASSOCIATION LLC

Table of content: (NPI 1093922064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093922064 NPI number — PEDIATRIC SUBSPECIALTY AND HOSPITALIST ASSOCIATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC SUBSPECIALTY AND HOSPITALIST ASSOCIATION 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:
1093922064
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:
621 PLAINFIELD RD
Provider Second Line Business Mailing Address:
#105
Provider Business Mailing Address City Name:
WILLOWBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-321-9811
Provider Business Mailing Address Fax Number:
630-321-9813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4440 W 95TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-684-5580
Provider Business Practice Location Address Fax Number:
708-684-4068
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SULAYMAN
Authorized Official First Name:
RABI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
708-684-5675

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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