1184810749 NPI number — FIBROMYALGIA TREATMENT CENTER OF AMERICA

Table of content: (NPI 1184810749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184810749 NPI number — FIBROMYALGIA TREATMENT CENTER OF AMERICA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIBROMYALGIA TREATMENT CENTER OF AMERICA
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:
1184810749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4332 N ELSTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60641-2144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-604-5321
Provider Business Mailing Address Fax Number:
773-604-5231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 BARRINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 3400 - DOCTOR OFFC BLDG 3
Provider Business Practice Location Address City Name:
HOFFMAN ESTATES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60169-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-843-5742
Provider Business Practice Location Address Fax Number:
847-490-4043
Provider Enumeration Date:
09/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SYMON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
773-604-5321

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , 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)





Copyright © 2007-2025 www.npivalidator.com