1740706266 NPI number — MR. JAMES D. VAIL IV DIETITIAN

Table of content: MR. JAMES D. VAIL IV DIETITIAN (NPI 1740706266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740706266 NPI number — MR. JAMES D. VAIL IV DIETITIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAIL
Provider First Name:
JAMES
Provider Middle Name:
D.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
IV
Provider Credential Text:
DIETITIAN
Provider Gender Code:
M

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:
1740706266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 GREEN BAY RD
Provider Second Line Business Mailing Address:
# 195
Provider Business Mailing Address City Name:
WINNETKA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60093-1721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-784-8812
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 GREEN BAY RD
Provider Second Line Business Practice Location Address:
# 195
Provider Business Practice Location Address City Name:
WINNETKA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60093-6009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-784-8812
Provider Business Practice Location Address Fax Number:
847-784-8812
Provider Enumeration Date:
08/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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