1558332940 NPI number — LAKE BARRINGTON WOMENS HEALTH CENTER PC

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 1558332940 NPI number — LAKE BARRINGTON WOMENS HEALTH CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE BARRINGTON WOMENS HEALTH CENTER PC
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:
1558332940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22N285 PEPPER RD
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
LAKE BARRINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60010-2539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-382-7330
Provider Business Mailing Address Fax Number:
847-382-9654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22N285 PEPPER RD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
LAKE BARRINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60010-5982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-382-7330
Provider Business Practice Location Address Fax Number:
847-382-9654
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEYER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SENIOR PARTNER
Authorized Official Telephone Number:
847-382-7330

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: 04900984 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CL2981 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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