1225071152 NPI number — STEPHEN A HERMES MD

Table of content: STEPHEN A HERMES MD (NPI 1225071152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225071152 NPI number — STEPHEN A HERMES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERMES
Provider First Name:
STEPHEN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1225071152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 S KENNEDY DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BRADLEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60915-2682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-933-0007
Provider Business Mailing Address Fax Number:
815-933-2776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S KENNEDY DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BRADLEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60915-2682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-933-0007
Provider Business Practice Location Address Fax Number:
815-933-2776
Provider Enumeration Date:
06/14/2006

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: 207RG0300X , with the licence number:  036056725 , 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)

  • Identifier: 791113742 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 174184 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4600191 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036056725 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5043293 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com