1710092564 NPI number — DIALYSIS CENTERS OF AMERICA - ILLINOIS, INC.

Table of content: DR. JOHN PATRICK FARRELL PH.D. (NPI 1316163090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710092564 NPI number — DIALYSIS CENTERS OF AMERICA - ILLINOIS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIALYSIS CENTERS OF AMERICA - ILLINOIS, INC.
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:
RCG ROGERS PARK
Provider Other Organization Name Type Code:
3
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:
1710092564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2277 W HOWARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60645-1922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-262-7147
Provider Business Mailing Address Fax Number:
773-262-5124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2277 W HOWARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60645-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-262-7147
Provider Business Practice Location Address Fax Number:
773-262-5124
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLANTON
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
781-699-9000

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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