1013005826 NPI number — PSYCHIATRIC ASSOCIATES SC

Table of content: (NPI 1013005826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013005826 NPI number — PSYCHIATRIC ASSOCIATES SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHIATRIC ASSOCIATES SC
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:
1013005826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
737 N MICHIGAN AVE
Provider Second Line Business Mailing Address:
SUITE 1200
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-373-7300
Provider Business Mailing Address Fax Number:
312-573-1249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
737 N MICHIGAN AVE
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-373-7300
Provider Business Practice Location Address Fax Number:
312-573-1249
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HANDLEY
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
312-373-7300

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01615704 . This is a "BC & BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com