1598163024 NPI number — MCHENRY COUNTY ORTHOPAEDICS, S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598163024 NPI number — MCHENRY COUNTY ORTHOPAEDICS, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCHENRY COUNTY ORTHOPAEDICS, S.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:
1598163024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 N IL ROUTE 31
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL LAKE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60012-3711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-356-5200
Provider Business Mailing Address Fax Number:
815-356-5262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10350 HALIGUS RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
HUNTLEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60142-9545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-356-5200
Provider Business Practice Location Address Fax Number:
815-356-5262
Provider Enumeration Date:
12/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DECREMER
Authorized Official First Name:
MANETTE
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
815-788-2018

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; 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