1578091971 NPI number — THE BOARD OF TRUSTEE FOR THE UNIVERSITY OF ILLINOIS

Table of content: (NPI 1578091971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578091971 NPI number — THE BOARD OF TRUSTEE FOR THE UNIVERSITY OF ILLINOIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BOARD OF TRUSTEE FOR THE UNIVERSITY OF ILLINOIS
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:
1578091971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7732 SOLUTION CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-7007
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:
10000 WEST O'HARE
Provider Second Line Business Practice Location Address:
TERMINAL 2
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60660-0508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-894-5100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BEGEMAN
Authorized Official First Name:
RHEA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR ADMINISTRATIVE OPERATIONS
Authorized Official Telephone Number:
312-413-0002

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036081301 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 338843610001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036070836 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 355387038001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036083148 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 359806839001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 361626360001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 593669702001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036114380 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0320685617 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 324401923001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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