1023275211 NPI number — OLGA L SAAVEDRA M.D. SC

Table of content: (NPI 1023275211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023275211 NPI number — OLGA L SAAVEDRA M.D. SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLGA L SAAVEDRA M.D. 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:
1023275211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1044 N MOZART ST
Provider Second Line Business Mailing Address:
SUITE 503
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60622-2789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-772-9607
Provider Business Mailing Address Fax Number:
773-772-9609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1044 N MOZART ST
Provider Second Line Business Practice Location Address:
SUITE 503
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60622-2789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-772-9607
Provider Business Practice Location Address Fax Number:
773-772-9609
Provider Enumeration Date:
05/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SAAVEDRA
Authorized Official First Name:
OLGA
Authorized Official Middle Name:
LIDIA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-772-9607

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  036099738 , 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: 292445 . This is a "WELLCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01632245 . This is a "BC/BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: G41051 . This is a "UPIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200003844 . This is a "FAM HEALTH NETWORK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 20000348 . This is a "ILLINOIS HEALTH CONNECT" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: N234055 . This is a "HARMONY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036099738 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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