1114996691 NPI number — SCOTT JAMES BARTHLAMA MS ATC LAT CSCS

Table of content: SCOTT JAMES BARTHLAMA MS ATC LAT CSCS (NPI 1114996691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114996691 NPI number — SCOTT JAMES BARTHLAMA MS ATC LAT CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTHLAMA
Provider First Name:
SCOTT
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS ATC LAT CSCS
Provider Gender Code:
M

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:
1114996691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
655 W IRVING PARK RD
Provider Second Line Business Mailing Address:
#414
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60613-3123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-450-9296
Provider Business Mailing Address Fax Number:
847-491-8865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 CENTRAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60208-0840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-491-5421
Provider Business Practice Location Address Fax Number:
847-491-8865
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , 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)





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