1699981449 NPI number — M. DARWISH MEDICAL CENTER

Table of content: (NPI 1699981449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699981449 NPI number — M. DARWISH MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M. DARWISH MEDICAL CENTER
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:
1699981449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 THORNHILL DR
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
CAROL STREAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60188-2795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-668-5530
Provider Business Mailing Address Fax Number:
630-668-5896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 THORNHILL DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
CAROL STREAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60188-2795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-668-5530
Provider Business Practice Location Address Fax Number:
630-668-5896
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DARWISH
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-668-5530

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  036047229 , 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: 0002201176 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036047229 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341910079 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1992715239 . This is a "NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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