1437524246 NPI number — MIDWESTERN UNIVERSITY

Table of content: (NPI 1437524246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437524246 NPI number — MIDWESTERN UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
MIDWESTERN UNIVERSITY
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:
MWU WELLNESS CENTER-DOWENRS GROVE CAMPUS
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:
1437524246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 31ST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-971-6401
Provider Business Mailing Address Fax Number:
630-515-7234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 31ST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-971-6401
Provider Business Practice Location Address Fax Number:
630-515-7234
Provider Enumeration Date:
12/04/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAUS
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SR. VICE PRESIDENT/CFO
Authorized Official Telephone Number:
630-515-7307

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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