1255646857 NPI number — ALIVIO MEDICAL CENTER INC

Table of content: (NPI 1255646857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255646857 NPI number — ALIVIO MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALIVIO MEDICAL CENTER INC
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:
1255646857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
966 W. 21ST STREET
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:
60608-4511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-254-1400
Provider Business Mailing Address Fax Number:
312-829-6375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6447 CERMAK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWYN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60402-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-829-6870
Provider Business Practice Location Address Fax Number:
312-829-6375
Provider Enumeration Date:
08/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CORPUZ
Authorized Official First Name:
ESTHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
312-829-6304

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001618612 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036113015 3 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141077 . This is a "MEDICARE TPAN NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 920890 . This is a "MEDICARE TPAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 141854 . This is a "MEDICARE TPAN NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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