1629043344 NPI number — THERAPEUTIC ENDOSCOPY ASSOCIATES PC

Table of content: (NPI 1629043344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629043344 NPI number — THERAPEUTIC ENDOSCOPY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC ENDOSCOPY ASSOCIATES PC
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:
1629043344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1730 PARK ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-2688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-718-0200
Provider Business Mailing Address Fax Number:
630-718-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
676 N SAINT CLAIR ST
Provider Second Line Business Practice Location Address:
SUITE 1525A
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-943-3723
Provider Business Practice Location Address Fax Number:
312-266-1411
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARSONS
Authorized Official First Name:
WILLIS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
630-718-0200

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01627695 . This is a "BLUE CROSS / BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com