1932305950 NPI number — GSP UNITED LLC

Table of content: (NPI 1932305950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932305950 NPI number — GSP UNITED LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GSP UNITED 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:
INTERIM HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1932305950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
188 W INDUSTRIAL DR
Provider Second Line Business Mailing Address:
SUITE 124
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60126-1623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-359-6660
Provider Business Mailing Address Fax Number:
630-279-7325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
188 W INDUSTRIAL DR
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60126-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-359-6660
Provider Business Practice Location Address Fax Number:
630-279-7325
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BULGER
Authorized Official First Name:
BERNARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-359-6660

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  2007-N0020 , 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: 611413200 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1633280 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 61271 . This is a "PRINCIPAL LIFE INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5911112669 . This is a "STATE OF WASHINGTON" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 000002649 . This is a "HUMANA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 371442495001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37308 . This is a "ALLIED HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5215621 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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