1154308518 NPI number — INSIGHT CHICAGO, INC.

Table of content: (NPI 1154308518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154308518 NPI number — INSIGHT CHICAGO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT CHICAGO, INC.
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:
INSIGHT HOSPITAL & MEDICAL CENTER CHICAGO
Provider Other Organization Name Type Code:
3
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:
1154308518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776473
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-2333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-567-2000
Provider Business Mailing Address Fax Number:
312-638-8320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 S MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-567-2000
Provider Business Practice Location Address Fax Number:
312-567-6156
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
810-275-9333

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  362170152 , 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: 00035 . This is a "BCBSIL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 362170152004 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 362170152001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006247 . This is a "STATE OF ILLINOIS LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 11727 . This is a "CITY OF CHICAGO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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