1811106198 NPI number — PHFM, LLC

Table of content: (NPI 1811106198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811106198 NPI number — PHFM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHFM, LLC
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:
1811106198
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7444 LONG AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60077-3214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-329-4100
Provider Business Mailing Address Fax Number:
847-329-4900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
627 WESTWOOD DR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028-2062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-931-9066
Provider Business Practice Location Address Fax Number:
636-937-2019
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
BEN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
847-329-4100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  033475 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101459402 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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