1164412417 NPI number — RADIATION ONCOLOGY CONSULTANTS, LTD

Table of content: (NPI 1164412417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164412417 NPI number — RADIATION ONCOLOGY CONSULTANTS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIATION ONCOLOGY CONSULTANTS, 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:
1164412417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 COMMERCE DR
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-698-0600
Provider Business Mailing Address Fax Number:
847-698-0601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 COMMERCE DR
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60523-1546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-698-0600
Provider Business Practice Location Address Fax Number:
847-698-0601
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARTSELL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-698-0600

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  042000055 , 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: 01615044 . This is a "BLUE SHIELD PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: CN5041 . This is a "RAILROAD MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62105 . This is a "ADVOCATE PHO GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: L007019 . This is a "CHAMPUS PIN" identifier . This identifiers is of the category "OTHER".




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