1558722884 NPI number — FALCON PERSPECTIVE P.C.

Table of content: DR. TIMOTHY H. BAGNELL DDS (NPI 1508973355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558722884 NPI number — FALCON PERSPECTIVE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALCON PERSPECTIVE P.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:
6
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:
1558722884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24120 CEDAR CREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-401-6241
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 E OGDEN AVE
Provider Second Line Business Practice Location Address:
SUITE NUMBER 645
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-401-6241
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SOKOL
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
815-401-6241

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  180.009732 , 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: 1689012668 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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