1922305242 NPI number — FIDELIS HEALTHCARE SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922305242 NPI number — FIDELIS HEALTHCARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIDELIS HEALTHCARE SERVICES, INC.
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:
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:
1922305242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 N MARTINGALE RD
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
SCHAUMBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60173-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-605-0501
Provider Business Mailing Address Fax Number:
847-517-1085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17625 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77058-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-954-3050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
847-605-0501

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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