1720332125 NPI number — MS. RENEA CHRISTINE MCKEOWN APN-BC

Table of content: MS. RENEA CHRISTINE MCKEOWN APN-BC (NPI 1720332125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720332125 NPI number — MS. RENEA CHRISTINE MCKEOWN APN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKEOWN
Provider First Name:
RENEA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APN-BC
Provider Gender Code:
F

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:
1720332125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4440 WEST 95TH STREET
Provider Second Line Business Mailing Address:
OUTPATIENT PAVILION, 6TH FLOOR
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-684-4327
Provider Business Mailing Address Fax Number:
708-520-1871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 W 95TH ST
Provider Second Line Business Practice Location Address:
POB SUITE 407
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-684-4327
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SA2200X , with the licence number:  209.009819 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X , with the licence number: 209-009819 , 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)





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