1629690185 NPI number — ILLINOIS RADIATION ONCOLOGY CONSULTANTS PLLC

Table of content: ALEXIS NOELLE OLIVEROS M.D. (NPI 1538302310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629690185 NPI number — ILLINOIS RADIATION ONCOLOGY CONSULTANTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ILLINOIS RADIATION ONCOLOGY CONSULTANTS PLLC
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:
1629690185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 483
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITCHFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62056-0483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-324-1100
Provider Business Mailing Address Fax Number:
217-324-1103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 FLAX DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62249-1396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-882-5621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MUDD
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
217-324-1100

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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