1326277005 NPI number — RESURRECTION SERVICES

Table of content: (NPI 1326277005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326277005 NPI number — RESURRECTION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESURRECTION SERVICES
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:
RESURRECTION AMBULATORY CARE SERVICES
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:
1326277005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6670
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER FOREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60305-6670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-675-8160
Provider Business Mailing Address Fax Number:
708-364-7474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2433 NORTH HARLEM AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-889-6355
Provider Business Practice Location Address Fax Number:
773-355-2815
Provider Enumeration Date:
07/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOBSON
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
SYSTEM DIRECTOR
Authorized Official Telephone Number:
773-797-3603

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0404X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1619414 . This is a "BCBS GRP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1636085 . This is a "BCBS GRP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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