1013017425 NPI number — FOX VALLEY PODIATRY OF MCHENRY COUNTY, LLC

Table of content: MR. PRESTON NGUYEN TANG MPH (NPI 1265797229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013017425 NPI number — FOX VALLEY PODIATRY OF MCHENRY COUNTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOX VALLEY PODIATRY OF MCHENRY COUNTY, 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:
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:
1013017425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2570 BARNHART ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60185-6160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-372-3913
Provider Business Mailing Address Fax Number:
630-372-2962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2570 BARNHART ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60185-6160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-372-3913
Provider Business Practice Location Address Fax Number:
630-372-2962
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HECK
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
LEANN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
630-372-3913

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , 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: POO118463 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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