1093827297 NPI number — MEDTEK DIAGNOSTICS INC

Table of content: (NPI 1093827297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093827297 NPI number — MEDTEK DIAGNOSTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDTEK DIAGNOSTICS 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:
1093827297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 CHANTICLEER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINSDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60521-5022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-747-3364
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E ARMY TRAIL RD
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
BLOOMINGDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60108-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-671-8346
Provider Business Practice Location Address Fax Number:
630-671-8301
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAFRI
Authorized Official First Name:
MAQSOOD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-747-3364

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001635998 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036099382 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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