1255478392 NPI number — ELGIN PAIN & HEADACHE CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255478392 NPI number — ELGIN PAIN & HEADACHE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELGIN PAIN & HEADACHE CENTER, 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:
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:
1255478392
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:
1975 LIN LOR LN
Provider Second Line Business Mailing Address:
SUITE 295
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60123-4902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-717-4790
Provider Business Mailing Address Fax Number:
630-762-9195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1975 LIN LOR LN
Provider Second Line Business Practice Location Address:
SUITE 295
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60123-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-717-4790
Provider Business Practice Location Address Fax Number:
630-762-9195
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ONWUTA
Authorized Official First Name:
J
Authorized Official Middle Name:
NNAEMEKA
Authorized Official Title or Position:
AUTHORIZED REPRESENTATIVE
Authorized Official Telephone Number:
847-717-4790

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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