1073646162 NPI number — PRIORITY CARE, INC.

Table of content: DR. TARA BISOGNA LAYNE DC (NPI 1003109976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073646162 NPI number — PRIORITY CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY CARE, INC.
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:
1073646162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 W DUNDEE RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
BUFFALO GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60089-3545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-229-3474
Provider Business Mailing Address Fax Number:
847-229-3475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 W DUNDEE RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BUFFALO GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60089-3545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-229-3474
Provider Business Practice Location Address Fax Number:
847-229-3475
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANGERT
Authorized Official First Name:
VAL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
773-501-9559

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01634458 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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