1124202031 NPI number — UNIVERSAL MEDICAL & REHABILITATION CENTER, S.C.

Table of content: (NPI 1124202031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124202031 NPI number — UNIVERSAL MEDICAL & REHABILITATION CENTER, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL MEDICAL & REHABILITATION CENTER, S.C.
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:
1124202031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9120 W GOLF RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NILES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60714-5806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-390-7122
Provider Business Mailing Address Fax Number:
847-390-7115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2828 W DEVON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60659-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-761-9774
Provider Business Practice Location Address Fax Number:
773-761-9878
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOHIUDDIN
Authorized Official First Name:
FATIMA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
18473907122

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036079439 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036092848 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0404246 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 21621391 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 335989271001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4140282 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 250733 . This is a "HARMONY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1156492 . This is a "FIRST HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 030004494 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 328026621001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110239089 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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