1528109006 NPI number — ASSOCIATED UROLOGICAL SPECIALISTS LLC

Table of content: (NPI 1528109006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528109006 NPI number — ASSOCIATED UROLOGICAL SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED UROLOGICAL SPECIALISTS 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:
6
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:
1528109006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10400 SOUTHWEST HWY
Provider Second Line Business Mailing Address:
LOWER LEVEL
Provider Business Mailing Address City Name:
CHICAGO RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60415-1367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-581-7308
Provider Business Mailing Address Fax Number:
708-274-4027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16632 107TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60467-8898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-349-6350
Provider Business Practice Location Address Fax Number:
708-349-9153
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROQUE
Authorized Official First Name:
ELIZA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
708-608-2195

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2088P0231X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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