1629020086 NPI number — PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK

Table of content: (NPI 1629020086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629020086 NPI number — PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
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:
1629020086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 W PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
URBANA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61801-9901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-443-5000
Provider Business Mailing Address Fax Number:
247-477-2761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 W PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61801-9901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-443-5000
Provider Business Practice Location Address Fax Number:
247-477-2761
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEUMAN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
224-273-0516

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0004861 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1708721 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000508360 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200475020A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com