1760550362 NPI number — PRIME TECH SERVICES INC

Table of content: MARIA ISABEL RODRIGUEZ RD (NPI 1861223406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760550362 NPI number — PRIME TECH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME TECH SERVICES 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:
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:
1760550362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2625 BUTTERFIELD RD
Provider Second Line Business Mailing Address:
SUITE 300S
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-573-1979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1460 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
DES PLAINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60016-4643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-573-1979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SULLIVAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-573-1979

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 070012781 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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