1669602744 NPI number — EARNEST WEBB, PC

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 1669602744 NPI number — EARNEST WEBB, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EARNEST WEBB, 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:
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:
1669602744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19516 NORTHWINDS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60411-8660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-251-5118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
849 MAPLE AVE
Provider Second Line Business Practice Location Address:
SUITE 903
Provider Business Practice Location Address City Name:
HOMEWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60430-2066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-799-5862
Provider Business Practice Location Address Fax Number:
708-799-0138
Provider Enumeration Date:
07/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WEBB
Authorized Official First Name:
EARNEST
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-799-5862

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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