1154348878 NPI number — ILLINOIS MATH AND SCIENCE ACADEMY

Table of content: (NPI 1154348878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154348878 NPI number — ILLINOIS MATH AND SCIENCE ACADEMY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ILLINOIS MATH AND SCIENCE ACADEMY
Provider Last Name:
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Provider's Other Name Information

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NPI Number Information

NPI Number:
1154348878
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:
343 BERWICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60506-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-896-1337
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SULLIVAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60506-1067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-907-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ATHLETIC TRAINER CERTIFIED
Authorized Official Telephone Number:
630-907-5992

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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)





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