1699801696 NPI number — TWENTY FIRST CENTURY PEDIATRICS

Table of content: MR. TRAVIS WILLIAM JOHNSON C.R.N.A. (NPI 1750315529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699801696 NPI number — TWENTY FIRST CENTURY PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWENTY FIRST CENTURY PEDIATRICS
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:
1699801696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 S WASHINGTON STREET
Provider Second Line Business Mailing Address:
SUITE 224
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-778-8800
Provider Business Mailing Address Fax Number:
630-778-8909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6010 IL-53
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LISLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-778-8800
Provider Business Practice Location Address Fax Number:
630-778-8909
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANKARI
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
630-778-8800

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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