1679647424 NPI number — NORTHWEST ORTHOPAEDIC ASSOCIATES DBA NORTHWEST PHYSICAL THERAPY

Table of content: (NPI 1679647424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679647424 NPI number — NORTHWEST ORTHOPAEDIC ASSOCIATES DBA NORTHWEST PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST ORTHOPAEDIC ASSOCIATES DBA NORTHWEST PHYSICAL THERAPY
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:
DBA NORTHWEST PHYSICAL THERAPY ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1679647424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7447 W TALCOTT
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-631-4112
Provider Business Mailing Address Fax Number:
773-594-2113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7447 W TALCOTT
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-631-4112
Provider Business Practice Location Address Fax Number:
773-594-2113
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCALL
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
773-631-7898

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225XH1200X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: CN2029 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1618851 . This is a "BCBS OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com