1093044281 NPI number — NAVAL HEALTH CLINIC GREAT LAKES ILLINOIS

Table of content: STEPHANIE LOPEZ (NPI 1265281612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093044281 NPI number — NAVAL HEALTH CLINIC GREAT LAKES ILLINOIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVAL HEALTH CLINIC GREAT LAKES ILLINOIS
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:
1093044281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3350 ILLINOIS STREET
Provider Second Line Business Mailing Address:
BLDG 1523
Provider Business Mailing Address City Name:
GREAT LAKES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60088-5230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-688-5568
Provider Business Mailing Address Fax Number:
847-688-4430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3350 ILLINOIS ST
Provider Second Line Business Practice Location Address:
BLDG 1523
Provider Business Practice Location Address City Name:
GREAT LAKES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60088-5230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-688-5568
Provider Business Practice Location Address Fax Number:
847-688-4430
Provider Enumeration Date:
12/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MORTON
Authorized Official First Name:
JOHNNA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
INDEPENDENT HOSPITAL CORPSMAN
Authorized Official Telephone Number:
847-688-5568

Provider Taxonomy Codes

  • Taxonomy code: 261QM1102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com