1831198837 NPI number — THOMAS J SCHEVERS PHD

Table of content: THOMAS J SCHEVERS PHD (NPI 1831198837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831198837 NPI number — THOMAS J SCHEVERS PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHEVERS
Provider First Name:
THOMAS
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

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:
1831198837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 COUGAR TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60013-6057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-444-0446
Provider Business Mailing Address Fax Number:
815-444-0446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4405 THREE OAKS ROAD
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-444-0446
Provider Business Practice Location Address Fax Number:
815-444-0446
Provider Enumeration Date:
07/20/2005

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: 103T00000X , 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: 05619771 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com