1801829395 NPI number — NOMC/MACNEAL RADIATION THERAPY JOINT VENTURE, LLC

Table of content: TORI LAINE MATHIS LPN (NPI 1033369681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801829395 NPI number — NOMC/MACNEAL RADIATION THERAPY JOINT VENTURE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOMC/MACNEAL RADIATION THERAPY JOINT VENTURE, LLC
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:
1801829395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIAWATHA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52233-0094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-826-3763
Provider Business Mailing Address Fax Number:
888-609-6019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 34TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWYN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60402-5591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-484-0011
Provider Business Practice Location Address Fax Number:
708-484-0549
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRUEGER
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
S
Authorized Official Title or Position:
GROUP ADMINISTRATOR
Authorized Official Telephone Number:
630-734-9560

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , 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: DE8968 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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