1457591802 NPI number — INDEPENDENCE PLUS INC

Table of content: (NPI 1457591802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457591802 NPI number — INDEPENDENCE PLUS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENCE PLUS 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:
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:
1457591802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 JORIE BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-2252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-366-4500
Provider Business Mailing Address Fax Number:
630-954-0091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 JORIE BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60523-2252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-366-4500
Provider Business Practice Location Address Fax Number:
708-366-4553
Provider Enumeration Date:
02/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
LES
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
708-366-4500

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  4000138 , 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: 0001620242 . This is a "BLUE CROSS BLUE SHIELD OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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