1265831101 NPI number — SOUTHWEST PHYSICIANS ASSOCIATES, S. C.

Table of content: MS. EVELYN MORRIS DURHAM FNP (NPI 1992175160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265831101 NPI number — SOUTHWEST PHYSICIANS ASSOCIATES, S. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST PHYSICIANS ASSOCIATES, 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:
1265831101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10749 CHERRYWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALOS PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60464-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-200-6615
Provider Business Mailing Address Fax Number:
708-598-3304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2955 W 95TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERGREEN PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60805-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-200-6615
Provider Business Practice Location Address Fax Number:
708-598-3304
Provider Enumeration Date:
08/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KHILFEH
Authorized Official First Name:
HAMDI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
708-200-6615

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036110790 , 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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