1609809565 NPI number — ALSIP INTEGRATED MEDICAL CENTER S C

Table of content: RICHARD SHANE BARTON M.D. (NPI 1275529083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609809565 NPI number — ALSIP INTEGRATED MEDICAL CENTER S C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALSIP INTEGRATED MEDICAL CENTER S 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:
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:
1609809565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9721 165TH ST
Provider Second Line Business Mailing Address:
STE 21
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60467-5657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-388-7500
Provider Business Mailing Address Fax Number:
708-942-8102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9721 165TH ST
Provider Second Line Business Practice Location Address:
STE 21
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60467-5657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-388-7500
Provider Business Practice Location Address Fax Number:
708-942-8102
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOROS
Authorized Official First Name:
BECKY
Authorized Official Middle Name:
ARLENE
Authorized Official Title or Position:
CLINIC DIRECTOR OWNER
Authorized Official Telephone Number:
708-388-7500

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  042617005 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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