1205837119 NPI number — WOMEN FIRST SPECIALISTS, S.C.

Table of content: (NPI 1205837119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205837119 NPI number — WOMEN FIRST SPECIALISTS, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN FIRST SPECIALISTS, S.C.
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:
WOMEN FIRST SPECIALISTS, S.C.
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:
1205837119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6121 N ELSTON AVE
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:
60646-4703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-792-0209
Provider Business Mailing Address Fax Number:
773-792-0112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6121 N ELSTON 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:
60646-4703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-792-0209
Provider Business Practice Location Address Fax Number:
773-792-0112
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HIDALGO
Authorized Official First Name:
RAYNELDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-792-0209

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  36059468 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 36087120 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VX0000X , with the licence number: 36112532 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: 36122486 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 36087120 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36112532 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36122486 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205837119 . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 36059468 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036112532 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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