1558467688 NPI number — MED CARE HEALTH MANAGEMENT CORPORATION

Table of content: (NPI 1558467688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558467688 NPI number — MED CARE HEALTH MANAGEMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED CARE HEALTH MANAGEMENT CORPORATION
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:
MEDCARE HMC
Provider Other Organization Name Type Code:
5
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:
1558467688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7820 GRAPHIC DR STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TINLEY PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60477-6278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-685-9025
Provider Business Mailing Address Fax Number:
773-685-9066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 E BUTTERFIELD RD STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOMBARD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60148-5612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-344-3100
Provider Business Practice Location Address Fax Number:
708-344-3131
Provider Enumeration Date:
09/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOXWALLA
Authorized Official First Name:
ABITURAB
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-825-4060

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  1010412 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: 1010412 , 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: 147899 . This is a "MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1012126 . This is a "IL DEPT OF PUBLIC HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".