1770734774 NPI number — MR. JAMES RICHARD GRIGALUNAS CO

Table of content: MR. JAMES RICHARD GRIGALUNAS CO (NPI 1770734774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770734774 NPI number — MR. JAMES RICHARD GRIGALUNAS CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIGALUNAS
Provider First Name:
JAMES
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CO
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:
1770734774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 SOUTH 5TH AVE
Provider Second Line Business Mailing Address:
ORTHOTIC LAB/ 121 HINES V.A. HOSPITAL
Provider Business Mailing Address City Name:
HINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-202-8387
Provider Business Mailing Address Fax Number:
708-202-2006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 SOUTH 5TH AVE
Provider Second Line Business Practice Location Address:
ORTHOTIC LAB/ 121
Provider Business Practice Location Address City Name:
HINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-202-8387
Provider Business Practice Location Address Fax Number:
708-202-2006
Provider Enumeration Date:
10/08/2008

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: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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