1346460292 NPI number — CENTRAL MEDICAL ASSOCIATES, S.C.

Table of content: ANDREA ESCUDERO (NPI 1558132068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346460292 NPI number — CENTRAL MEDICAL ASSOCIATES, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL MEDICAL ASSOCIATES, 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:
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:
1346460292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W CENTRAL RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
MT PROSPECT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60056-2347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-259-3383
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W CENTRAL RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
MT PROSPECT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60056-2347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-259-3383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARAZO
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
847-259-3383

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036082737 , 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: 0002207312 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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