1306913454 NPI number — CHICAGO METROPOLITAN OBSTETRICIANS & GYNECOLOGISTS, LTD

Table of content: (NPI 1306913454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306913454 NPI number — CHICAGO METROPOLITAN OBSTETRICIANS & GYNECOLOGISTS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICAGO METROPOLITAN OBSTETRICIANS & GYNECOLOGISTS, LTD
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:
1306913454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4685
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:
60680-4685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-333-3030
Provider Business Mailing Address Fax Number:
708-333-7453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15620 S. WOOD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60426-4171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-333-3030
Provider Business Practice Location Address Fax Number:
708-333-7453
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
ERNEST
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
708-333-3030

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 036043976 , 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: 036100768 JAMES , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036110499 REDHEAD , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1447283445 . This is a "NPI NUMBER REDHEAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01630253 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036043976 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1306913454 . This is a "CMOB NPI NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1659385128 . This is a "NPI NUMBER JAMES" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 212568 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 207V00000X . This is a "PROVIDERS TAXONOMIES" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 212568 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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