1437437811 NPI number — LYMTHERA CHICAGO LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437437811 NPI number — LYMTHERA CHICAGO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LYMTHERA CHICAGO LLC
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:
1437437811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 SAINT CHARLES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70130-5223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-288-8748
Provider Business Mailing Address Fax Number:
866-725-5119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 N LAKE SHORE DR
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-3427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-288-8748
Provider Business Practice Location Address Fax Number:
866-725-5119
Provider Enumeration Date:
08/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SCALISE
Authorized Official First Name:
MEGHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ADMINISTRATOR
Authorized Official Telephone Number:
312-288-8748

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , 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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