1356647960 NPI number — RESURRECTION SERVICES

Table of content: (NPI 1356647960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356647960 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:
THE CENTER FOR CANCER CARE
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:
1356647960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 564437
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:
60656-4437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-583-7310
Provider Business Mailing Address Fax Number:
708-583-9870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 N LAKE SHORE DR
Provider Second Line Business Practice Location Address:
7 EAST
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-5640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-661-5800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMICK
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VICE PRESIDENT
Authorized Official Telephone Number:
708-583-6817

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  036120969 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RX0202X , with the licence number: 036058899 , 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: 036058899 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036120969 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 041243519 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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