1730625500 NPI number — JOHNSON MEDICAL SERVICES S.C.

Table of content: FRANCO D'ALFONSO RN (NPI 1518593763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730625500 NPI number — JOHNSON MEDICAL SERVICES S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON MEDICAL SERVICES S.C.
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:
1730625500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27W132 BARNES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60190-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-379-9759
Provider Business Mailing Address Fax Number:
630-933-1933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 W 132 BARNES AVE/
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-379-9759
Provider Business Practice Location Address Fax Number:
630-933-1933
Provider Enumeration Date:
01/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
TAYLOR
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
630-379-9759

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036050297 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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