1578064077 NPI number — RELIABLE VISITING PHYSICIANS INC

Table of content: (NPI 1578064077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578064077 NPI number — RELIABLE VISITING PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIABLE VISITING PHYSICIANS 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:
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NPI Number Information

NPI Number:
1578064077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7331 N LINCOLN AVE STE 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLNWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60712-1766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-860-9044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W CENTRAL RD STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PROSPECT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60056-2381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-376-8144
Provider Business Practice Location Address Fax Number:
847-376-8597
Provider Enumeration Date:
02/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RANOCO
Authorized Official First Name:
ADOLF VON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
224-723-3527

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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