1891729869 NPI number — CITY OF WAUKEGAN ILLINOIS

Table of content: DR. CARILYN HUNT SPARKS M.D. (NPI 1437443124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891729869 NPI number — CITY OF WAUKEGAN ILLINOIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF WAUKEGAN ILLINOIS
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:
1891729869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-577-8811
Provider Business Mailing Address Fax Number:
847-577-7967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 BELVIDERE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUKEGAN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60085-6201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-249-5410
Provider Business Practice Location Address Fax Number:
847-249-5607
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GALLAGHER
Authorized Official First Name:
PAT
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
847-249-5410

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  7275 , 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: 4920251 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 590013130 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 614345800 . This is a "DEPT OF LABOR OFFICE OF WORKER COMP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".