1508212317 NPI number — OCCUPATIONAL HEALTH CENTERS OF ILLINOIS, P.C.

Table of content: KEVIN R. LONG A.R.N.P. (NPI 1992759740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508212317 NPI number — OCCUPATIONAL HEALTH CENTERS OF ILLINOIS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCCUPATIONAL HEALTH CENTERS OF ILLINOIS, P.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:
1508212317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4714 GETTYSBURG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17055-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1528 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61201-8612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-732-2990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
YALDO
Authorized Official First Name:
RAAD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-972-1100

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com