1104807890 NPI number — SALWA F ASAAD

Table of content: (NPI 1104807890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104807890 NPI number — SALWA F ASAAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALWA F ASAAD
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:
6
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:
1104807890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 379
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60462-0379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-774-2970
Provider Business Mailing Address Fax Number:
708-460-1117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 COPPERFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60432-2054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-722-1818
Provider Business Practice Location Address Fax Number:
815-722-2533
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ASAAD
Authorized Official First Name:
SALWA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
708-774-2970

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09932277 . This is a "BCBS IL GROUP#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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