1962849083 NPI number — PRESENCE ST. JOSEPH HOSPITAL - ELGIN

Table of content: DR. GREGORY ANTON RUFENER MD (NPI 1538663703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962849083 NPI number — PRESENCE ST. JOSEPH HOSPITAL - ELGIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESENCE ST. JOSEPH HOSPITAL - ELGIN
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:
1962849083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 REMINGTON BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-5114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-914-2417
Provider Business Mailing Address Fax Number:
630-914-2499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 N AIRLITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60123-4912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-742-4646
Provider Business Practice Location Address Fax Number:
847-622-3460
Provider Enumeration Date:
05/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
MELVONNE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER, CREDENTIALING
Authorized Official Telephone Number:
630-914-2417

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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